The lead article in today’s New York Times, “Treatment Cost Could Influence Doctors’ Advice,” purports to convey a change in doctors’ procedures to evaluate price as well as effectiveness in considering drugs or operations for their patients.
In reality, doctors have been performing this function all along. Growing up in a medical family, I have more exposure to the way things work, and if a patient is in the last year of his life, the doctor will take that into account in prescribing a course of action.
One thing that has changed, however, is the openness with which this process is now being used and recommended. Medical societies are publishing recommendations that include a cost benefit analysis. And insurance companies and others are considering treatment cost per quality-adjusted life year. This statistic includes the long-term effectiveness of a drug so doctors or patients don’t engage in a reckless at-all-costs wild goose chase.
We are all going to pass away eventually, and some patients and doctors need to come to terms with that reality in treating patients as well. Plus, if a patient will be financially ruined after a successful treatment — well, that comes under the imperative of “do no harm.”
Some may consider the process of evaluating medical costs as a form of rationing. But I say that “bedside rationing” has been going on since the beginning of modern medicine.