nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Friday, February 11, 2011

Utilitarian Health Care: The Best For The Most, Except For The Rest

I've been reviewing some of the literature on "outcomes-based" health care.  So far, a lot of promises, but not a lot of concrete evidence to show it works to improve care or costs.

Along the way, I came across a commentary in the Journal of the American Medical Association that addressed how another country is looking at an outcome-type system.  The article began with the following:
"The core purpose of a health system should be to maximize the health of the population. When the main challenge is managing long-term conditions, maintaining health rather than delivering health care per se should be the goal. "
--Toward an Outcomes-Based Health Care System: A View From the United Kingdom. JAMA. 2010;304(21):2407-2408. James Mountford, MD, MPH; Charlie Davie, MD
They lost me right there.

This is utilitarian thinking, the greatest benefit for the greatest number.  It works in the "macro" perspective, and can be argued effectively when you're talking about population vaccination rates.

But, it ignores the fate of those who don't benefit, just because most others do.  And I think, philosophically, that is an unethical approach to patient care (at the "micro" level).

I"m not talking about "death panels."  Where this would work to your harm is when you need a type of care that has been judged not to "maximize the health of the population."  You just have to "give it up" for the team, whether it's cancer chemo or an expensive type of surgery.

I don't think of myself as a population.  I think I'm pretty unique.

Doc D

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