Contemporary cost containment measures ignore patients' need for privacy, destroy long-term doctor-patient relationships, and demand ethical and standard of care compromises.Economic considerations have distracted the physician and he/she no longer focuses primarily on the patient's welfare. The superficiality of the doctor-patient relationship and the cost-cutting efforts have jointly contributed to the deterioration of the quality of medical care.

Patients' wishes regarding health care and dying must be taken into consideration by their physicians. Competent patients need to record directives about their care in advance of a crisis situation. The primary care physician, seeing the patient at the time of a routine office visit, is in a favorable position to explore and record attitudes. A patient's value system should be part of a medical history before hospital admission. Details in a Value History Questionnaire facilitate guiding an incompetent patient through (...) a terminal illness in accordance with wishes previously expressed.An instrument in the form of a questionnaire was designed to record the attitudes of 200 patients regarding health care and dying. Respondents ranged in age from 17 to 84 years, and all were members of one family practice. They reacted positively to the opportunity to record their values, opinions, and wishes about their health care and process of dying. They clearly indicated that, in the absence of prior directives, they would want their families consulted about crucial decisions. (shrink)