In the September 15, 2011 issue of The New England Journal of Medicine, there is an article, Breast-Cancer Screening, which focuses on the updated evidence and recommendations for screening women who are at average risk for breast cancer that have been published since this topic was last reviewed in the Journal, in 2003. (http://www.nejm.org/doi/full/10.1056/NEJMcp1101540)
The section of the article, Strategies And Evidence For Screening, begins with the following sentence: “The decision to screen either a particular population or a specific patient for a disease involves weighing benefits against costs.” These costs include financial costs.
My view is that bringing the dollar bill to bear upon decision making in the practice of medicine undermines this decision making and conflicts it, which then undermines the doctorpatient relationship, the essence of medicine.
Doctor– decision making–Patient
Should medical decision making have to occur in the context of financial considerations? I say the answer to this is ABSOLUTELY NOT !
Let’s approach this from the opposite direction. Suppose a doctor orders tests or does procedures with his/her own financial remuneration in mind. Wouldn’t we all say that this is OUTRAGEOUS ? Wouldn’t we all say that this is a FINANCIAL CONFLICT OF INTEREST that absolutely CANNOT BE ALLOWED ?
This article says, “The decision to screen either a particular population or a specific patient for a disease involves weighing benefits against costs.” Who, which individuals, decided that this is so, that it is okay for the dollar bill to be brought into play and bear upon medical decision making? And for whom do these individuals work? From whom do they derive their salary? Is it possible that their financial remuneration can ultimately be traced back to one of the third-party payers in our healthcare system, either the private payers or the public payers?
R. Garth Kirkwood, MD