Barry Kisloff, MD
Potential Conflicts of Interest: None disclosed.
Kisloff B.; High-Value, Cost-Conscious Care. Ann Intern Med. 2013;158:142-143. doi: 10.7326/0003-4819-158-2-201301150-00025
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Published: Ann Intern Med. 2013;158(2):142-143.
TO THE EDITOR:
Smith and colleagues' article (1) about the creation of a curriculum to instruct physicians in the provision of “high-value, cost-conscious care” makes several assumptions of dubious validity. There is the unfounded belief that sufficient high-quality, evidence-based pathways exist to provide a framework of instruction toward this goal. Most commonly encountered health care issues are engulfed in legitimate controversy (2–4), and with ongoing research, an evidence-based pathway that has modest validity today might well have little legitimacy in the near future. Providing even the best-supported recommendation for an evidence-based pathway must still be tempered by patient preference (5) and the threat of litigation should an enforced best-practice, cost-conscious pathway yield an undesired result.
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