From the Editor

Like many clinicians, I have noticed that my patients are asking more detailed and comprehensive questions about their therapy. They often bring articles or even material from the World Wide Web to the Department during a consultation or a physical exam. Best selling authors have put the vocabulary of the health care "focused-factory"1 into everyday usage. What's going on here? Where did this consumerism in health care come from and where might it take us? Some experts believe that, historically, patients (health care "consumers") have been largely passive participants in the health care process, generally uninformed about treatment alternatives, and unconcerned with prices. In some sense, expectations were limited and largely controlled by providers.2 Market observers today note that this is far from the case, and point to several forces that have coalesced to make consumers savvier shoppers of health care. These forces include consumers shouldering more of their own health care costs, employers giving employees more choices about their health plans, a perceived backlash against managed care, and the revolution of information technology and growth of th