MMS Ethics Forum: Cost-Conscious Medicine

The overriding refrain in medical care over the last several years has been persistent if nothing else:  “the continuing cost of medical care is unsustainable.”  The subsequent calls for “cost-conscious medicine” have been ringing louder and more frequently.  The trend is inevitable, as governments at all levels, businesses of all sizes, and individuals who buy coverage struggle with strained budgets and rising costs.

The efforts for cost control in the Commonwealth culminated this year with Chapter 224, the cost-containment law passed earlier this year by the legislature.

So what might be the impact on physicians? How should physicians react? And what could it mean for patient care?

Some answers came from the 2012 Interim Meeting’s Ethics Forum, Serving Two Masters – What Practicing Cost-Conscious Medicine Means for Patient Care and the Public Trust.

Presenters included James E. Sabin, M.D., Clinical Professor in the Departments of Population Medicine and Psychiatry at Harvard Medical School and Director of the Harvard Pilgrim Health Care Ethics Program, and Martin Samuels, M.D., Professor of Neurology at Harvard Medical School and Neurologist-in-Chief and Chairman of the Department of Neurology at Brigham and Women’s Hospital and Co-Chair of Partners Neurology.

Over nearly two hours, the physicians offered their perspectives on the issue and the direction that physicians might take in today’s practice environment of ever-increasing fiscal constraints. Some excerpts from their presentations:

Dr. Sabin – “Implementing cost-conscious medicine will take time and will not be easy…the biggest impediment is more emotional than intellectual…We must involve patients and the public in our deliberations and policy-making…They will only trust the concept of cost-conscious medicine if they believe the quality of care is preserved and the savings will be used for good purpose.Physicians are the crucial players in this endeavor, we can be spoilers or leaders….It is our responsibility to make it work.”

Dr. Samuels – “The important question is which master do we serve? … Simultaneously considering the interests of society and the individual patient represents an irresolvable conflict of interest… Overutilization is expensive and dangerous….Errors are unavoidable, despite our best efforts, and without errors, we have no progress…Believe in the concept that physicians are required to do everything that they believe may benefit each patient, without regard to costs or the societal considerations…because the best individual care is cost effective.”


  1. Charlee Harvey says:

    I am able to see the benefits as well as the difficulty we will face in our effort to control healthcare cost. The cost control measures will allow healthcare to improve overal through improved utilization of resources. A future benefits of cost control is breaking the long time cycle of rapidly rising healthcare cost. A disadvantage of implementing cost control measures is that patients may not receive the level of treatment they need because it ,may seem too expensive.

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