Some experts frame this issue as a choice between promoting the best interests of individual patients and promoting those of society. Often this is a false dichotomy. Ultimately, the health of any population depends, at least in part, on access to affordable medical care. If physicians shirk their duty to act as financial stewards when making medical decisions, the end result will be worse health outcomes for the population at large. In the context of antibiotics, most physicians already recognize the link between their individual medical decisions and population health. They need to recognize that population health is similarly linked to the utilization of expensive and marginally beneficial medical care. At the bedside, that means being willing to trade a low chance of a small benefit to individual patients for a larger benefit to other patients, as clinicians do when forgoing marginally beneficial antibiotics. More generally, it means that as professional societies expand on the Choosing Wisely campaign, they should not limit themselves to harmful or unnecessary interventions but should also target care that brings minimal benefits to individual patients at a financial cost that ultimately threatens the health of many other patients.
–Peter Ubel and Reshma Jagsi, The New England Journal of Medicine
I’m sympathetic to the idea of trading individually small benefits for collective large ones, especially when public or pooled resources subsidize the benefits. However, it is very easy to see how this issue is framed as a choice between benefiting an individual vs society. After all “small benefits” and “minimal benefits” to individuals are still benefits, though potentially gained at the expense of larger ones to many others. This dichotomy is unfortunate, but I’m not sure it’s false.
Finally, a good way to promote the status quo is to provide greater financial reward for (potentially minimal) benefits to individual patients than for societal benefits. Is there a conflict between patient-centered care and population health?
