Tuesday, January 3, 2012

Ethics and the Practice of Medicine

In an editorial by Ezekiel Emanuel, the, in my opinion, erstwhile proponent of medical care limiting and rationing, in the Annals of Internal Medicine the author states regarding the recently released Ethics Manual for the members of American College of Physicians (ACP):

But then the ACP Committee elaborates a very significant obligation: 

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. . . . 

Most physicians were inculcated that ideal physicians are thorough, comprehensive, and exhaustive in their workups and treatments—and ignore costs in the process. Here is an authoritative medical body using such words as “efficient” and “parsimonious”—and without “qualifications”—to describe the ideal physician’s practices. And to be sure it is not missed, this statement is placed in a “call-out” box. This is truly remarkable.

The issue here is the use of parsimony. Now one can interpret that in many ways. For example for lower back pain an MRI may not be the first step in determining the problem. Fifty years ago there was no MRI and the physician used their knowledge of anatomy to isolate the problem and recommend a course of treatment. And of course all too often an MRI finds what may require additional investigation which in turn is oftentimes costly and of no benefit. Parsimony in treatment may mean focus, focus, focus, but it could in the author's words mean cheap, cheap, cheap.

This may be the next step in the current health care debate.