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Should Doctors Be 'Parsimonious' With Your Health Care?


Endless experts have told us that health care costs keep increasing and that the country needs to do something to hold them in check, but is being "parsimonious" with health care decisions really the best, ethical solution?

A major medical group thinks so.

The new ethics manual for the American College of Physicians (ACP) recommends that doctors practice "parsimonious care" -- in other words,  they should consider both cost and medical benefit when deciding how to treat their patients.

The ACP, the second-largest doctors' group after the American Medical Association, published the manual this week for its 132,000 internists nationwide.

Using the term "parsimonious" struck some as harsh, but ACP president Virginia Hood argued that considering cost-effectiveness not only protects patients from costly and potentially dangerous tests and treatments they may not need, it insures that there are enough health care dollars to go around for everyone.

In an interview, Hood  told  NPR that the cost of health care in the U.S. is "twice that of any other industrialized countries and we are not providing care to as many people as they do in other places, and we don't even have as good outcomes."

She said doctors need to think harder about the expensive, often invasive tests and treatments they give their patients. More is not always better; in fact, it can often do more harm than good, she said.

This echoes a recent  study that found that Americans 75 and older are unnecessarily being given colonoscopies, Pap smears and prostate cancer screening.

On the other hand, many doctors call for tests to protect themselves against malpractice suits, which can send their already high malpractice insurance premiums even higher.

In an editorial accompanying the new guidelines, bioethicist Ezekiel Emanuel, M.D., a professor at University of Pennsylvania and a former White House health policy advisor, called them "truly remarkable" for taking on this controversial issue so clearly and directly.

Others weren't so sure.

Scott Gottlieb, M.D., of the American Enterprise Institute, a conservative think tank, thought the term parsimonious "really implies that care should be withheld."

"There's no definition of parsimonious that I know of that doesn't imply some kind of negative connotation in terms of being stingy about how you allocate something," he told NPR.

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