The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Editorial

The Problem with Parsimony (and the Prioritization of Prudence)

Authors: Charles G. Kels, JD, Lori H. Kels MD, MPH

Abstract

Estimates suggest that nearly one-third of total healthcare expenditures can be attributed to nonbeneficial practices.1 In response, ethical debate about the physician’s role in cost containment has shifted from the allocation of scarce resources to the avoidance of waste.2 This evolution underscores the crucial distinction between eschewing unnecessary tests and treatments because doing so is best for individual patients versus the collateral benefit of increasing access to healthcare services that may ensue from eliminating waste. To the extent that “parsimonious medicine” is driven by the goal of improving patient outcomes and reducing iatrogenic complications, its ethical foundations rest upon the core tenets of professionalism (beneficence and nonmaleficence), as opposed to notions of distributive justice associated with rationing.3

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References

1. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012; 307: 1513–1516.
 
2. Brody H. From an ethics of rationing to an ethics of waste avoidance. N Engl J Med. 2012; 366: 1949–1951.
 
3. Tilburt JC, Cassel CK. Why the ethics of parsimonious medicine is not the ethics of rationing. JAMA. 2013; 309: 773–774.
 
4. Cassel CK, Guest JA. Choosing wisely. JAMA. 2012; 307: 1801–1802.
 
5. ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002; 136: 243–246.
 
6. American Medical Association. Code of medical ethics, opinion 9.0652: physician stewardship of health care resources. http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion90652.page. Accessed June 1, 2013.