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Medical Ethicists Urge Caution in Teaching High-Value Care - 12/13/2016

Medical Ethicists Urge Caution in Teaching High-Value Care

Release Date: December 13, 2016
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Calling for an “unwavering focus on the primacy of patient welfare,” a pair of medical ethics scholars urges careful consideration of how the concept of high-value care (HVC) should be integrated in medical education.

The JAMA Viewpoint published Dec. 6 states, “If primacy of patient welfare is to truly remain fundamental to the profession, instilling commitment to this principle should be the most critical ethical value instilled in cultivating professional identity.”

If “value” is considered the ratio of health benefits achieved per unit of cost, value can be increased in several ways: increasing health benefits, decreasing costs or accepting less health benefit as a trade-off for cost savings.

Teaching approaches that overemphasize cost savings “could risk causing trainees to lose sight of individual patient welfare or create unintended consequences for subsequent bedside decision-making,” write authors Matthew DeCamp, M.D., Ph.D., assistant professor of medicine at the Johns Hopkins University School of Medicine, and Kevin Riggs, M.D., M.P.H.

“Physicians must sometimes balance ethical tension between cost saving and patient welfare. The best way to do this is unsettled among ethics scholars and practicing physicians. This lack of consensus could lead to inexperienced medical trainees misunderstanding their duty,” says DeCamp, who is also a faculty member at the Johns Hopkins Berman Institute of Bioethics.

The consequences could be damaging to both the physician-patient relationship and the profession, the authors say. “[A]mbiguity regarding the primacy of patient welfare in HVC education risks patient distrust and societal backlash against what might be perceived as training future physicians to control costs at the expense of patient welfare,” they write.

The authors do believe that the concept of value can be ethically introduced in medical education, but the distinct perspectives of patients, organizations and society must be included, and how value is taught may need to be tailored to medical trainees’ level of experience.

“Early on, it may be more appropriate to focus on teaching medical students to communicate about costs with patients. Later, more complex concepts of value could be introduced,” DeCamp says. “This is much the same way we teach in other areas of medicine — blood draws first, heart catheterizations later.”

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