Thursday, December 5, 2013

Inappropriate "Appropriateness"

Dr. Wes Fisher asks a good question, "What happened to doctors serving as advocates for their patients?"

In particular, he notes how doctors are being increasingly expected to adhere to externally imposed "appropriateness" criteria for treating patients -- which may or may not be what's actually right for the individual patient.

Of course, guidelines and criteria can be helpful adjuncts to experienced clinical judgment. But they cannot replace that judgment.  The issue will become increasingly important as physician payments (or penalties) are increasingly linked to how whether or not a physician adheres to (or strays from) those criteria.

In the worst case, these criteria create a serious conflict of interest for the physician -- will doctors do what's right for their patients?  Or will they adhere to the criteria, even at the patient's expense?