Friday, August 15, 2014

The inappropriate conflation of medical stewardship and distributive justice

This piece from a few months ago in the Southern Medical Journal challenges the group think of today's policy makers. It's a must read. It makes the point that the clinician's responsibility is to the individual patient, not the medical commons. Excellence in the care of the individual patient, of course, includes eliminating waste in terms of the excesses (nonbeneficial or even harmful care) which could be categorized as low value. And while such good stewardship will have the collateral effect of easing the burdens of resource allocation the physician's job is to treat the patient, not society. Here are a few gems from the article:

A professional commitment to distributive justice in the clinical context unavoidably undercuts the core historical commitments of medical professionalism. This is because physicians owe a fiduciary duty to the individuals under their care...
The idea of converting waste into value and having physicians (rather than “government”) take the lead in doing so, is intrinsically attractive, to say the least; yet it is important to keep in mind that the collateral benefits procured through prudent care are just that. Clinicians owe a fiduciary duty to the patient, not the world.


james gaulte said...

Amen. This is a theme I have been obsessed with at least since the publication of the New Professionalism and have blogged often about it. I am glad to see a few others share my general views on this, for the most part. To read the article you reference requires a subscription.I wish their article would get wider notice than usually happens with an article in the SMJ.


R. W. Donnell said...

The last sentence says it all.