February 24, 2011
In my piles of articles that I was sorting and filing today, I came across one written by Molly Cooke, a medical doctor. She published a piece in the New England Journal of Medicine [http://www.nejm.org/doi/full/10.1056/NEJMp0911502] that appeared in 2010, volume 362, pages 1253-1255. The article’s title is, ‘Cost consciousness in patient care — What is medical education’s responsibility?’
I was moved to print a copy of this article when it first came into my email on one of the many list serves to which I subscribe. I was reminded of why that was the case as I reread the contents. Dr. Cooke notes that while debate about costs of care has been a focus of society’s discourse relating to health for decades, medical education curricula seldom address how and when cost enters planning of diagnosis and treatment strategies.
Dr. Cooke addresses historical, philosophical, structural, and cultural explanations for this reality. One of the historical events relates to efforts for clinical pharmacists to guide doctors’ understanding about prescibing and testing. The ‘academic detailing’ veture, as it was labeled, made little difference in prescribing or other habits.
Dr. Cooke notes that doctors consider themselves to be patient advocates and, as such, want to focus on benefits for a patient, not the cost associated with accessing those benefits. Structurally, she describes an educational setting in which medical education students work in hospital settings where the primary goal is to get a patient out of the hospital. If discharge is the first aim, she believes that doctors learn to order any test they can to achieve that aim via evidence that a patient is ready to be let go. So, there is no time to learn about possible cost-effective approaches… Isn’t this a bit ironic? In the name of cost-saving, perform possibly unnecessary tests to discharge a patient sooner rather than later? If anyone has the data out there to show how that works out for the economic benefit of health care, pleasure share it…
