Responsibility for medical care has landed on the shoulders of patients with a resounding thud. I don’t mean choice of doctors; we’ve always had that (if we aren’t among the nation’s poor), and with managed care, we surely have less of it than we had before. I mean choice about what the doctors do. The tenor of medical practice has shifted from one in which the all-knowing, paternalistic doctor tells the patient what must be done—or just does it—to one in which the doctor arrays the possibilities before the patient, along with the likely plusses and minuses of each, and the patient makes a
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