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Considering the costs of treatment while making clinical decisions

Considering the costs of treatment while making clinical decisions

The headline of the front page New York Times article caught my attention: “Cost of Treatment May Influence Doctors.” The piece read in part:

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.

In reading further, I discovered that one of Stanford’s cardiologists, Paul Heidenreich, MD, was a c0-chair of the policy review that led to new guidelines from the American College of Cardiology and the American Heart Association. I thought it would be interesting to delve deeper in a 1:2:1 podcast with Heidenreich about why, as he told the Times, “we couldn’t go on just ignoring costs.” Did escalating health-care costs that are consuming GDP spur the action? Are these guidelines a threat to individual decision-making between a physician and patient? And, what role do patients have in these decisions? Shouldn’t they be included in potential key life-and-death verdicts?

I was also especially intrigued by a quote from the societies’ paper outlining the changes: “Protecting patients from financial ruin is fundamental to the precept of ‘do not harm.’ ” Hmm… a new take on the Hippocratic Oath that I’ve never considered.

Why the new guidelines?  Just consider for a moment the iconic rock lyrics of Bob Dylan. They say it all:

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone
If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’

Previously: Personal essays highlight importance of cost-conscious medical decisions and Educating physicians on the cost of care

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