Promisekeeping: an institutional ethos for healthcare today.

The relationship between a physician and a patient, which survived unchanged for decades--indeed centuries--has in recent years undergone a serious change due to the advent of managed care. Controlling costs and maximizing profits are now as equally important as medical concerns, and ethical, economic, and political issues have forever changed the way physicians perform their duties. This article proposes the concept of promisekeeping as a remedy to the sometimes contradictory positions in which patients and providers find themselves. Composed of honesty, explicit disclosure, flexible decision making, and, most of all, beneficence, promisekeeping is one method to ensure that all parties in the managed care system can succeed.