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ARTICLE |

Managed Care, Managing Uncertainty

David M. Mirvis, MD; Cyril F. Chang, PhD
Arch Intern Med. 1997;157(4):385-388. doi:10.1001/archinte.1997.00440250023003.
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THE "MANAGED care" paradigm has challenged most aspects of conventional health systems. Debate abounds on the efficacy,1 ethics,2 and finance3 of these systems. Meanwhile, enrollment in managed health systems continues to rise4 as employers urge employees to opt for lower-cost health plans and as states reform Medicaid systems to control governmental budgets.5

To understand the issues that managed care presents to the health care endeavor, it is important to understand what is managed. The implied object may be the budget, the physician, health care resources, or, more optimistically, the care of the patient. In this essay, we suggest that one object that is managed is uncertainty.

UNCERTAINTY IN MEDICAL PRACTICE  Uncertainty is a fact of life in medical practice. We, as physicians, usually do not know unequivocally the full extent of a patient's disease and even less often do we know the best single approach

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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