Laurel J. Lyckholm, MD and Arwa K. Aburizik, MD, MS
Decision-making capacity can be preserved in patients with mental illness and should be formally assessed in the context of their values and past decisions.
AMA J Ethics. 2017;19(5):444-453. doi:
10.1001/journalofethics.2017.19.5.ecas4-1705.
Measuring outcomes alone is not the answer. There should be a way to reward the doctor for educating a patient about lifestyle modifications and then documenting that the care provided followed patient preferences.
Acknowledging the roles and views of the caregiver may be the first step to resolving disagreements between caregivers and clinicians over artificial nutrition at the end of life.
AMA J Ethics. 2017;19(7):656-662. doi:
10.1001/journalofethics.2017.19.7.ecas3-1707.
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.
The Moseley study found no significant difference between those in the arthroscopic lavage and debridement arm of the study and those in the sham surgery arm.
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.