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Cost Effectiveness

Contributing Voices
Steven Peskin, MD

The following paragraph is from the American College of Physicians Ethics Manual, 6th Edition:

“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. In making recommendations to patients, designing practice guidelines and formularies, and making decisions on medical benefits review boards, physicians' considered judgments should reflect the best available evidence in the biomedical literature, including data on the cost-effectiveness of different clinical approaches. When patients ask, they should be informed of the rationale that underlies the physician's recommendation.“

With synonyms for parsimonious that include miserly, stingy, and frugal, it is no surprise that this word choice evoked some criticism. The preponderance of the Ethics Manual advocates that the physician’s primary obligations and duties are to the patient, exercising beneficence, confidentiality, and honesty, with the best interest of the patient being paramount. The paragraph above is a small, but important, segment of the Ethics Manual.