Focus factor: Should your doctor be thinking about society's healthcare costs?

Article Highlights

  • It is critical that patients can have confidence that their physicians are offering them the best medical advice

    Tweet This

  • Perhaps physicians have something to learn from our colleagues in the law

    Tweet This

  • When I read about supposed moral imperative to be responsible stewards of the public healthcare dollar--Yes, I worry.

    Tweet This

You probably want your doctor to care about people, but how much do you want her to care about all of them? That's the question I ask when I read articles-generally by bioethicists, often respectable ones-asserting that one of the moral responsibilities of physicians is to be responsible stewards of the healthcare dollar.

This rhetoric concerns me, because I worry it may ultimately degrade the already-challenged physician-patient relationship.

The cornerstone of medicine, the most fundamental principle, in my mind, is the absolute, rock-solid belief that your doctor is your unqualified advocate and will work as hard as possible to provide you with the best medical treatment possible, as if you were a member of her own family (Dr. Marty Samuels and I originally described this as "The Uncle Marvin Test").

"I shudder to imagine the conversation they might have around the social utility of withholding care from your grandmother (or one of theirs)." -- David Shaywitz

To be clear: this doesn't mean the most expensive pills-by all means prescribe or substitute an equivalent generic, when available. This doesn't mean the most expensive diagnostic studies-it's generally in the patient's medical interest to avoid unnecessary procedures that usually carry some intrinsic risk and also can lead to false positive results that can in turn lead to needless anxiety--and on occasion, permanent harm. This doesn't mean extra days in the hospital-a hospital is one of the world's most dangerous places, and it's often in a patient's best interest to be discharged as soon as possible (see here if you need more convincing). And this doesn't mean any intervention the patient requests-as Atul Gawande has poignantly described, sometimes helping a patient decide not to pursue a likely futile therapy is the right thing for a doctor to do (although, as I previously wrote in a NYT op-ed, I've also seen some doctors abandon hope prematurely).

But it is critical that patients can have confidence that their physicians are offering them the best medical advice, and not to worry that their doctors are trying to somehow balance the costs associated with the care of an individual patient with the broader healthcare needs of the society at large.

In part, my concern stems from an inherent distrust of those who claim to be looking out for "the people," and who express generic and often patronizing concern for the unnamed masses, as in my experience, this professed concern is often coupled to remarkable contempt for individual people.

I recall with anguish and disgust a coterie of college progressives who would make regular pronouncements about the need for "power to the people," then would systematically go through the pages of the dormitory facebook, rating and ripping on the students one by one. I shudder to imagine the conversation they might have around the social utility of withholding care from your grandmother (or one of theirs).

Not only am I inherently distrustful of those who claim to be swayed by the interests of "the people," but on a more practical level, I'm not sure it's even possible to meaningfully weigh these two factors in a particular instance-an argument made cogently by Milton Weinstein here.

We clearly live in a world of limited resources-though I admit I've always been a deep believer in Paul Famer's view that we should aspire to provide the best medical care to each patient, and not accept a lower standard of care for the poor or, as I increasingly worry about, the elderly.

Perhaps (and it pains me to say this), physicians have something to learn from our colleagues in the law. It could be that we are better served by an adversarial system of some kind, where at least you can trust your doctor, rather than by a system in which physician's role is to assess not only your disease but your relative value to society.

We're not there yet, but when I read about the supposed moral imperative to be responsible stewards of the public healthcare dollar-yes, I worry. And so should you.

David Shaywitz, M.D., is a adjunct scholar at AEI.

Also Visit
AEIdeas Blog The American Magazine
About the Author

 

David
Shaywitz

What's new on AEI

AEI Election Watch 2014: What will happen and why it matters
image A nation divided by marriage
image Teaching reform
image Socialist party pushing $20 minimum wage defends $13-an-hour job listing
AEI on Facebook
Events Calendar
  • 27
    MON
  • 28
    TUE
  • 29
    WED
  • 30
    THU
  • 31
    FRI
Monday, October 27, 2014 | 10:00 a.m. – 11:30 a.m.
State income taxes and the Supreme Court: Maryland Comptroller v. Wynne

Please join AEI for a panel discussion exploring these and other questions about this crucial case.

Tuesday, October 28, 2014 | 9:30 a.m. – 12:15 p.m.
For richer, for poorer: How family structures economic success in America

Join Lerman, Wilcox, and a group of distinguished scholars and commentators for the release of Lerman and Wilcox’s report, which examines the relationships among and policy implications of marriage, family structure, and economic success in America.

Tuesday, October 28, 2014 | 5:30 p.m. – 7:00 p.m.
The 7 deadly virtues: 18 conservative writers on why the virtuous life is funny as hell

Please join AEI for a book forum moderated by Last and featuring five of these leading conservative voices. By the time the forum is over, attendees may be on their way to discovering an entirely different — and better — moral universe.

Thursday, October 30, 2014 | 2:00 p.m. – 3:00 p.m.
A nuclear deal with Iran? Weighing the possibilities

Join us, as experts discuss their predictions for whether the United States will strike a nuclear deal with Iran ahead of the November 24 deadline, and the repercussions of the possible outcomes.

Thursday, October 30, 2014 | 5:00 p.m. – 6:15 p.m.
The forgotten depression — 1921: The crash that cured itself

Please join Author James Grant and AEI senior economists for a discussion about Grant's book, "The Forgotten Depression: 1921: The Crash That Cured Itself" (Simon & Schuster, 2014).

No events scheduled today.
No events scheduled this day.
No events scheduled this day.
No events scheduled this day.
No events scheduled this day.