Perspective:

The medical profession has traditionally rewarded the broadest differential diagnosis and a patient care approach that uses resources as though they were unlimited. But with health care costs threatening to bankrupt our country, the financial implications of medical decision making have become part of the national conversation. The real goal of optimal medical care should not be ‘cost consciousness’ per se, but better use of evidence-based medicine and Bayesian principles. Whether it’s due to lack of time, fear of ‘missing something,’ simple ignorance, or concerns about getting sued, the incentives to do ‘more’ often overwhelm our impulse to use resources wisely and appropriately. Educational reformers are now offering us an added ethical incentive. Thinking logically, helping a patient become well enough to climb the stairs to his apartment is meaningless if medical care leaves him unable to afford that apartment. Medical bills are after all among the leading causes of personal bankruptcy in the United States. Protecting our patients from financial ruin is fundamental to the principle of doing no harm.