Physicians should understand and be sensitive to all of the issues that affect patients when they prescribe the tertogenic medication isotretinoin for treatment of acne vulgaris.
To be a useful tool for assessing quality of physician care, pay-for-performance must be designed to include process measures and to not penalize physicians for treating patients with difficult-to-manage conditions.
Appropriate use of the pay-for-performance system may improve quality of care by counteracting physician incentives to overtreat in fee-for-service situations or undertreat in capitation plans.
Professional, practical, clinical and cultural obligations should guide decision making when a funding agency restricts the types of counseling and advice it allows medical professionals to dispense.