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A recent survey of physician prescribing practices found that “…53.1% of surveyed physicians reported having personally refrained within the past 6 months from using specific clinical services that would have provided the best patient care, because of health system cost. Prescription drugs (n = 1073 [48.3 %]) and [MRI] (n = 922 [44.5 %]) were most frequently rationed.”
This suggests physicians have a sense of moral hazard on behalf of the entire healthcare system. This raises a fascinating ethical question as the physician’s duty it to first treat the patient before them, but should we consider the larger systemic and public health impact of using an expensive resource in a system over-burdened by costs? Is this happening because we feel like the other parts of the system are failing to control costs and we know that care is already being rationed on price & not in the way that is best for everyone as a society? Should we make point of care cost-effectiveness data available in EMRs & encourage doctors to have shared decision making conversations with patients comparing cost-effectiveness a quality process metric?