Op-Ed: ACP Doctors, Thank You for Acknowledging a Law of the Universe

Resources are finite. They just are. This is not an opinion, it is a law of the universe.

Yet, for my lifetime, I have been incredibly frustrated by medicine’s cultural and practical lack of acknowledgement of this law.

FINALLY, the American College of Physicians (ACP) got it. Kaiser Health News describes the revelation:

The American College of Physicians hit a nerve when it released an updated ethics manual calling for doctors to provide “parsimonious care” – in other words, “to practice effective and efficient health care and to use health care resources responsibly.”

This recommendation, included in the Jan. 3 Annals of Internal Medicine special supplement, drew immediate reaction – and not just because of its use of the infrequently heard “parsimonious.” It’s been viewed as a definitive statement of medical ethics directed at the organization’s 132,000 members – physicians who practice internal medicine and its related specialties, among them cardiology and oncology, that often involve expensive procedures. And, the guidance comes at a time when health care costs are central to the national policy debate.

My personal reactions to this are very mixed.

At one level, I experience relief and even exuberance. FINALLY, we can begin to address a root cause of the problems in our health care non-system. We cannot make progress as long as medicine is living in a fantasy world that the laws of economics don’t apply and that resources to take care of patients are infinite.

At another level, I am still shaking my head. History will write up this event similar to the way that today we view abolition of slavery: “How could we have rationalized a WRONG view of the world for all these years?”

If the headline were written up in The Onion, it would read something like

“4 Billion Years After Creation of Earth, Medicine Acknowledges Economics as a Science”

I shared the Kaiser Health News article with a college friend who has a unique background — he is a neurosurgeon with an undergraduate degree in economics.

Thanks for interesting article, Vince. My old undergraduate professor of Medical Economics used to say that medicine was somehow immune from the laws of economics and that was in 1975. Generally most docs get that they and the society have to be cost conscious but challenge is how to get there. Patients and their families have to be educated as well. And for reinforcement, as in all OECD countries, we need strict practice guidelines. Yesterday I assisted for the third time on a 59 year old lady with widely metastatic colon cancer to the spine, and everywhere else, sadly. Each time my neurosurgeon friend takes it out it comes back. She and her family want ‘everything done.’ The problem in a nutshell. –p

So, ACP doctors…thank you for getting it right…finally.


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