Leah M. Marcotte, MD, Jeffrey Krimmel-Morrison, MD, and Joshua M. Liao, MD, MSc
Individuals can underperform in circumstances of shared accountability. In clinical settings, this is an unintended consequence of the health care sector’s complexity fragmentation.
AMA J Ethics. 2020;22(9):E802-807. doi:
10.1001/amajethics.2020.802.
This comic conveys the absurdity of overreliance on symptom measures and excessive testing in contemporary clinical decision making and health care practice.
AMA J Ethics. 2020;22(9):E816-817. doi:
10.1001/amajethics.2020.816.
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.
When talking to physicians about practice variation, “Why does hospital A have higher cesarean rates than Hospital B?” is likely to be more effective than “Why does Doctor A have higher cesarean rates than Doctor B?”
Oliver Schirokauer, PhD, MD, Thomas A. Tallman, DO, MMM, Leah Jeunnette, PhD, Despina Mavrakis, MBA, and Monica L. Gerrek, PhD
An educational initiative is described in which medical and bioethics students observe health care in an urban jail for two days and reflect on their learning.
AMA J Ethics. 2017;19(9):845-853. doi:
10.1001/journalofethics.2017.19.9.peer1-1709.
Nonmaleficence must not be sacrificed in the name of the patient’s autonomy, but there is no need to undertake needlessly invasive treatments for a small boost in protection against cancer recurrence if the patient does not wish to do so.
It is an understandable human reaction to feel defensive in the face of evidence that challenges one's practices, but it is imperative that we rise above this with a modicum of humility and ask the tough questions: what causes problems and how can we avoid them in the future?
While practicing evidence-based medicine may maximize the likelihood of positive outcomes in a large population, it does not necessarily yield the best decision in a particular situation. To date, EBM proponents have not figured out how to account for patients’ differences from trial subjects, intangible factors detectable by experienced doctors, and patients’ values.