In one of his few decisions addressing the interface of law and medicine, Oliver Wendell Holmes observed that, The patient has no more right to all the truth than he has to all the medicine in the physician’s saddlebag. He should only get so much as is good for him.

During the last 60 or so years, the question of how much medical information is indeed good for the patient has been the subject of innumerable lawsuits. From this plethora of litigation, a clear common law trend which favors maximum disclosure of information has become evident. Relying upon the fiduciary nature of the physician-patient relationship, the courts have imposed upon the physician a duty to inform a patient fully regarding the condition of his or her body. It is appropriate, therefore, to examine various exemplary case decisions in an effort to portray effectively the nature and scope of the physician’s rights and responsibilities in this context.

The recent flurry of antitrust litigation in the health care industry is forcing the courts to reevaluate the legality of existing health care institutions under the Sherman Antitrust Act. One type of institution that poses significant antitrust questions is the independent practice association (IPA), an arrangement which consists of a contractual relationship between subscribers, physicians and an IPA corporate entity. The physicians agree to provide medical services to the IPA's subscribers, who pay a flat rate. In exchange, physicians are reimbursed at rates usually established by a fee schedule.

The Health Maintenance Organization Act of 1973 requires that an IPA, like an HMO, must “assume full financial risk on a prospective basis for the provision of basic health services…” This ensures that the IPA bears the risk that the cost of the services it renders will not exceed the value of the premiums it collects, giving it an incentive to contain costs.

The American Nurses’ Association (ANA) and its affiliate state nurses’ associations (SNAs) claim to represent the interests of all registered nurses in this country.’ In reality, an uneasy schism of professional ideology has developed within these organizations. The ANA believes that the state and district nurses’ associations are qualified to act and should act as the exclusive agents of their respective memberships in the important fields of economic security and collective bargaining. In fact, in 1977, 100,000 registered nurses, then somewhat less than 10 percent of all working RNs, were under union contract through an SNA. Yet the leadership in the ANA and SNAs is dominated by nurses who are either supervisors or educators in their daily professional roles. The ANA has identified the director of nursing in any given hospital as the legitimate leader of that nursing staff: “Nursing administration has the responsibility and authority for the quality of nursing practice within the health care organization.” Yet the collective bargaining process itself often pits nursing staff against nursing leadership within a given facility.

Aparamount issue facing registered nurses in the eighties is the choice of trade union or professional association representation for purposes of collective bargaining. This act of choice recasts the profession's historical dilemma. The question no longer is whether professionalism is compatible with collective bargaining but rather, “Which labor organization shall represent me?”

History will record and interpret these events. As president of the American Nurses’ Association, my task is not to be reflective but to speak out. Will the profession's collective bargaining contracts be articulated by truck drivers, teachers, electricians, jewelry makers, and meatcutters rather than nurses? Who best can represent the professional and economic interests of nurses?

Let there be no mistake about it; the nursing profession is under siege by trade unions. This is not simply a battle for contracts, but for control of our right to speak in our own behalf on all issues confronting the profession.

The nursing shortage has gained national attention, generating a television network special as well as a lengthy article in the NEW YORK TIMES SUNDAY MAGAZINE, ith much speculation as to causes and solutions. And, while some health care institutions are trying new and creative ways to attract nurses (such as the much-publicized work-everyweekend- have the-rest-of-the-weekoff plan developed by one Texas hospital), others are reducing their bed capacities or attempting to fill the gaps with overtime or temporary personnel.