Case and Commentary
Jan 2005

The 50-Milligram Difference, Option Comparison

Jennifer Reenan, MD
Virtual Mentor. 2005;7(1):101-105. doi: 10.1001/virtualmentor.2005.7.1.ccas17b-0501.


Because option C fulfills Dr. Troy's primary obligation to Mr. Ria and also informs him of the financial incentives in the background of their patient-physician relationship, it is preferable. Even though option B, continuing to write a prescription for 50-mg tablets, does not inform Mr. Ria of the financial incentive, one could argue that it is an acceptable alternative because it respects Mr. Ria's preference. Dr. Troy does not gain direct benefit from Mr. Ria's prescription at 50- or 100-mg doses; he only benefits if improving the practice's profile lowers costs down the road. It is preferable to inform Mr. Ria of the financial incentive. This will allow Dr. Troy to inform Mr. Ria that health care costs rise whether or not Mr. Ria pays for them out of his own pocket.

Because option A undermines Dr. Troy's obligations to Mr. Ria and fails to inform him of the financial incentive that motivates Dr. Troy's insistence, it should be avoided.

Preferable: Option C

Acceptable: Option B

Avoid: Option A

Additional discussion and information


Virtual Mentor. 2005;7(1):101-105.



The people and events in this case are fictional. Resemblance to real events or to names of people, living or dead, is entirely coincidental. The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.