This commentary on a case considers a transgender patient’s mental health and risk for DVT in ethical decision making about feminizing gender-affirming hormone therapy.
AMA J Ethics. 2023;25(6):E386-390. doi:
10.1001/amajethics.2023.386.
Lee C. Zhao, MD, Gaines Blasdel, Augustus Parker, and Rachel Bluebond-Langner, MD
Tension between realistic goals and unrealistic views about how to achieve them is compounded when patients are eager to revise a prior surgeon’s gender-affirming procedure.
AMA J Ethics. 2023;25(6):E391-397. doi:
10.1001/amajethics.2023.391.
Dr Eric Plemons joins Ethics Talk to discuss facial feminization surgery and how clinicians can best support patient decisions about gender-affirming care.
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.
The objective is to compare the costs of providing the same level of quality. When resource-use and quality measures are juxtaposed, the resources used to provide the same level of quality can be compared.
The picture that emerges from study of physician economic behavior is mixed, but from the intensity of responses by some professional societies to Medicare's coding modifier proposal, it appears that economic incentives matter a lot to many of their members.
Many team members such as nurses and medical assistants have key roles in meeting practice goals but receive little if any performance-based compensation. In part, nursing union rules create a barrier by inhibiting trials of productivity-based pay or shared-risk models.
This process of developing EBM-based guidelines and applying them to clinical care highlights the tension between generating unbiased knowledge based on statistical aggregation and the application of this information to individual patients.