Should doctors weigh dollars when making choices about care?
New ACP guidelines call for 'parsimonious' treatment
Topics: Appropriateness, Quality, Performance Improvement, Cost and Productivity, Efficiency, Physician Issues
January 04, 2012
Taking a provocative position on cost control, the American College of Physicians (ACP) is urging physicians to be ethical by practicing "parsimonious" treatment.
In the sixth edition of ACP's Ethics Manual, published in the Annals of Internal Medicine, the group emphasizes each physician's duty to "practice effective and efficient health care, and to use health care resources responsibly." ACP notes that "[p]arsimonius 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."
According to ACP President Virginia Hood, the guidelines are intended to reduce overall health care costs and improve patient care. "We also have to realize that if we don't think about how resources are used in an overall sense then there won't be enough health care dollars for our individual patients," Hood said. "So while concentrating on our individual patients and what they need, we also [need] to think on this bigger level both for their benefit and for the well-being of the community at large."
In an accompanying editorial, University of Pennsylvania bioethicist Ezekiel Emanuel lauded ACP's recommendations. "Here is a professional society unafraid of advocating the principle of cost-effectiveness," he wrote. "These positions on efficiency, parsimony, and cost-effectiveness constitute an important shift, if not in ethics then in emphasis."
However, some health care experts argue that the guidelines could imply that physicians in some cases should ration care. Calling the recommendations "alarming," the American Enterprise Institute's Scott Gottlieb said, "Parsimonious, to me, implies an element of stinginess and stinginess implies an element of subterfuge" (Stein, NPR, 1/2; Stein, "Shots," NPR, 1/3; Frieden, MedPage Today, 1/3).
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