Subject(s)
Arthritis, Rheumatoid/drug therapy , Practice Guidelines as Topic , Practice Patterns, Physicians'/statistics & numerical data , Antirheumatic Agents/therapeutic use , Complementary Therapies , Humans , Medicine , Occupational Therapy/statistics & numerical data , Outcome Assessment, Health Care , Patient Compliance , Patient Selection , Physical Therapy Modalities/statistics & numerical data , Primary Health Care/statistics & numerical data , Specialization , United StatesABSTRACT
While most health care is provided at the primary care level, little research has been done to document the ethical issues of such care. A stratified random sample of 702 physicians, nurses, physical therapist, and physician assistants within one southeastern state was surveyed to determine the frequency of ethical issues in primary care. The most frequently occurring issue concerned moral decisions about the amount of time to spend with each patient. A comparison of physician and nonphysician professional groups revealed significant differences in frequencies of the issues. Age had a slight impact on the responses, while gender, religion, and region of practice had none. The study showed that the most frequently occurring issues are pragmatic, not dramatic, and center on patient self-determination, adequacy of care and professional responsibility, and distribution of resources.
Subject(s)
Attitude of Health Personnel , Ethics, Medical , Primary Health Care , Bioethical Issues , Health Care Rationing , Humans , Patient Advocacy , Quality of Health Care , Random AllocationABSTRACT
The decision to contain medical costs, which is a political and social decision, entails restriction of medical services. To guide public policy, research on the impact of such restriction must be carried out, but this type of research differs significantly from most other medical research. Difficult issues concerning informed consent arise, with potential conflicts among principles of maximization of good and minimization of harm to the patient, the patient's right to self-determination, and the utilitarian goal of maximization of collective welfare. We have discussed these principles in the context of relationships between patient and physician and between subject and investigator. Approaches considered include emphasis on retrospective studies, use of statistical techniques to formulate clinical decision-making rules on the basis of available data, three-celled randomization designs, and the role of the primary-care physician in maximizing patient autonomy and minimizing the potentially threatening aspects of informed consent for such studies.
KIE: In the design of medical cost containment research, potential conflicts develop among the principles of maximization of good and minimization of harm to the patient, the individual's right to autonomy, and the augmentation of societal welfare. Particularly difficult issues involving informed consent arise because such research lacks therapeutic intent, introduces unknown risks, and generates questions of equity in the allocation of resources. Statistical decision theory techniques and retrospective studies are advocated to obviate these concerns.
