Parsimonious Care, in the Best Sense

Steven R. Peskin, MD, MBA, FACP

The following paragraph is from the American College of Physicians Ethics Manual, 6th Edition:

“Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available. In making recommendations to patients, designing practice guidelines and formularies, and making decisions on medical benefits review boards, physicians' considered judgments should reflect the best available evidence in the biomedical literature, including data on the cost-effectiveness of different clinical approaches. When patients ask, they should be informed of the rationale that underlies the physician's recommendation.“

With synonyms for parsimonious that include miserly, stingy, and frugal, it is no surprise that this word choice evoked some criticism. The preponderance of the Ethics Manual advocates that the physician’s primary obligations and duties are to the patient, exercising beneficence, confidentiality, and honesty, with the best interest of the patient being paramount. The paragraph above is a small, but important, segment of the Ethics Manual.

While we might reasonably debate word choice, my view is that the College made the right call to highlight our vital need for physicians to recognize their role and responsibilities related to efficient and effective clinical practice. One microcosm in medicine that is an instructive example is antibiotic stewardship. We have seen the adverse clinical and, to a lesser extent, economic consequences of injudicious overuse of antibiotics. It is time for judiciousness with a dose of parsimony.

Steven R. Peskin, MD, MBA, FACP, is medical director of Horizon Healthcare Innovations, Horizon Blue Cross Blue Shield of New Jersey, and associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School.

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