This week, my good friend Reshma Jagsi and I published an article in the New England Journal of Medicine, in which we explain why physicians are doing their job, as physicians, when they pay attention to healthcare costs. Here is a snippet from that article, and a link to find the full version.
Health care costs are straining budgets throughout the developed world, threatening the fiscal solvency of governments, employers, and individuals. Many countries are trying to restrain health care spending through top-down approaches, such as price regulation and even refusal to reimburse for interventions that are not cost-effective. Still controversial is the role that physicians should play in controlling health care costs. For instance, the Choosing Wisely campaign of the American Board of Internal Medicine Foundation encourages physicians to avoid interventions that “may be unnecessary, and in some instances can cause harm,” but it does not ask physicians to contemplate trading off small clinical benefits for individual patients in order to promote more general societal welfare.
Yet concern for societal interests has long been recognized as part of physicians’ duties. Physicians’ specialized knowledge and skills result from publicly funded graduate medical education and the hands-on learning afforded to them by patients who allow trainees to participate in their care. In turn, physicians gain an obligation, as members of a uniquely privileged profession, to serve not only their individual patients but also society.
Consider the campaign launched by the Centers for Disease Control and Prevention to promote “antibiotic stewardship.” The campaign recognizes that aggressive use of antibiotics in patients who are unlikely to benefit from their use promotes the development of antibiotic resistance, a serious public health problem. Thus, a physician who believes that an individual patient has only a small chance of benefiting from an antibiotic might choose not to prescribe one, out of a desire to forestall resistance in the population at large. Such societal stewardship involves forgoing a small, or even uncertain, benefit for an individual patient in order to promote the health and well-being of the general population.