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In Health Care, is it Wiser to be a Miser?

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The American College of Physicians has issued a new ethics manual recommending that physicians use resources responsibly by practicing “parsimonious” care.

The manual, published as a supplement to the Jan. 3 issue of Annals of Internal Medicine, noted that a physician's first duty is always to the patient, but added, "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." –medpage today

What does parsimonious care mean? Naysayers will of course argue that it means “death panels” will be established to withhold care for those in genuine need. Parsimonious care doesn’t mean that. It just means that doctors will make an effort to order the tests and procedures it takes to diagnose and heal a patient effectively, and that’s it—nothing extra. If you were having a problem with your car and the mechanic said to you, I can figure out what’s wrong with a simple $150 test, or I can do the $150 test followed by a $1000 high-tech test to corroborate the findings of the simple test, almost nobody would opt for the follow-up test. Why spend all this extra money on redundancy when the same job can be done more efficiently for less? That’s what parsimonious care means.

Moreover, before insurance companies were Fortune 500 companies, parsimonious care was actually the standard of care. To explore how and why the cost of health care has skyrocketed in the past two decades, surgeon Atul Gawande visited the city of McAllen, Texas, which has the hightest health care costs in the nation, examining facilities and interviewing providers and administrators:

I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?

Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill.

And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.

“Oh, she’s definitely getting a cath,” the internist said, laughing grimly. –New Yorker

Were doctors 15 years ago negligent? Was their approach governed by the laws of a death panel? Of course not. They were parsimonious. If they returned to that type of behavior, it would be a good thing.