american college of physicians


Author: Let The National Debate On ‘Parsimonious Medicine’ Begin


Uh oh. I just looked up the official definition of “parsimonious” and found, “characterized by or showing parsimony; frugal or stingy.” Receiving “frugal” medical care would be just fine with me.”Stingy,” not so much.

My dictionary-diving was prompted by the controversial new ethics guidelines just put out by the American College of Physicians, the country’s second-largest medical group. As NPR reported, the new guidelines include this language:

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.”

I asked Georgetown University’s double-threat doctor-lawyer, M. Gregg Bloche, for his take on the new guidelines and their implications. He’s the author of the book, “The Hippocratic Myth: Why Doctors Have to Ration Care, Practice Politics, and Compromise their Promise to Heal.” He replied by email:

The new ACP ethics guidelines on the place of cost in clinical judgment take a step forward by affirming that costs ought to count. But the guidelines fail to explain how costs should count. This failure is likely to beget confusion, unfairness, and distrust.

‘The ACP’s murkiness on the matter of whether and how to balance benefits against costs sets the stage for case-by-case, subjective judgment about the value of people’s lives and well-being.’

The guidelines call upon physicians to “practice effective and efficient health care” and to provide “[p]arsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient.” That care should be “effective” is a clear-cut proposition. Treatment that’s futile in the sense that it stands no chance of making a positive therapeutic difference shouldn’t be provided. This ought to be a no-brainer. Regrettably, it’s often honored in the breach. So the ACP has done a service by reminding its members of this bit of ethical common sense.

The ACP’s call for doctors to practice “efficient” and “parsimonious” care is another matter.

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