Tuesday, January 10, 2012

Part II: Does parsimonious equal ethical?

It might be that the American College of Physicians would be wiser to not use what amounts to a technical term better understood by an audience they're mostly not addressing in this document.

Read in context, I think it should not be difficult for most readers to get the meaning intended. The full quotation from this article is as follows:

"Physicians have a responsibility to practice effective and efficient health care, and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available."

Seems pretty clear to me.

Given the number of very expensive, situationally ineffective, even risky or harmful, and oftentimes unnecessary-but-for-"defensive medicine" scans and interventions that are ordered so long as someone (Medicare/Medicaid/Tri-Care/insurance) will pay . . . I'm having a hard time getting too worried about ACP finally using the "p" word with physicians.

It appears to me, rather, that it is Gottlieb who gets it wrong here, if quoted accurately: "I mean, that really implies that care should be withheld." Does it? Or is he constructing a straw man?

Even if we correct his misuse of the term "care" (surely he means to say "treatment"), the only real implication I see is that of encouraging a wiser, more equitable use of healthcare resources.

While we might not want to put that responsibility fully on the shoulders of clinicians--the rest of us as patients and parents/families, politicians and other policy makers, have as much or greater responsibility to choose and use wisely--physicians too need to get on board so that fewer trains to nowhere good never leave the station.

Tarris Rosell, PhD, DMin
Rosemary Flanigan Chair
Center for Practical Bioethics



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