When new doctors take the Hippocratic Oath, they pledge to "apply for the benefit of the sick, all measures...required."
Should doctors factor in the cost of treatment, too? Drs. Lisa Rosenbaum and Daniela Lamas, two editorial fellows at The New England Journal of Medicine, make the case that -- as health care becomes increasingly expensive -- there's a compelling reason that they should:
Our profession has traditionally rewarded the broadest differential diagnosis and a patient care approach that uses resources as though they were unlimited. Good care, we believe, cannot be codified in dollar signs. But with health care costs threatening to bankrupt our country, the financial implications of medical decision making have become part of the national conversation.
Many who have been in practice for decades argue that at no point, no matter the economic environment, should cost factor into physicians' decisions. After all, this is not the first time in history when recession has loomed. Each generation, notes Martin Samuels, chair of the Department of Neurology at Boston's Brigham and Women's Hospital, has been led to believe it's on the precipice of doom and that unless it considers the greater good, society will unravel. But Samuels cautions that when physicians start weighing society's needs as well as those of individual patients, they begin to lose the essence of what it means to be a doctor. When we lose our personal responsibility to individual patients, he says, “We are in deep trouble.”
The consideration of health-care costs in determining the course of treatment is, unsurprisingly, a thorny issue in medicine. It can quickly beget accusations of "rationing" and "death panels."
At the same time, however, it seems to be a conversation that doctors are becoming increasingly engaged in. Earlier this spring, nine medical societies voluntarily drew up lists of five "unnecessary" treatments they currently provided, in the hopes of changing how their members practiced medicine.
A new nonprofit called Costs of Care has started designing modules to teach medical students about factoring costs into their medical decisions. Their motto: "All doctors should understand how the decisions they make impact what patients pay."
Cost consciousness is not part of the Hippocratic Oath yet. But it does look to be a subject that doctors increasingly want to engage in -- even with all the pitfalls that could lie ahead.