Anthony N. Galanos, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
Galanos A.; Helping Physicians Recognize Bedside Rationing. Ann Intern Med. 1997;126:921. doi: 10.7326/0003-4819-126-11-199706010-00032
Download citation file:
Published: Ann Intern Med. 1997;126(11):921.
TO THE EDITOR:
Drs. Ubel and Goold  are to be applauded for helping physicians define and recognize when they are rationing at the bedside. Indeed, the medical literature reflects that silent rationing  and implicit rationing  have been and continue to be commonplace. My concern is that clinicians may not only ration without awareness but also execute their biases when they do so. Elderly persons, for example, are particularly vulnerable to this type of bedside rationing.
Although we may know that the fastest-growing segment of our population is persons 85 years of age and older, it may not be as obvious that proposals to ration care based on age have been in the literature for more than a decade . Various studies document efficacy and cost-effectiveness in treating older patients, yet elderly patients continue to be labeled as the primary drain on the budget. We obfuscate the discussion by pitting grandparents against grandchildren for the health care dollar. Add physician-assisted suicide, futility guidelines, and capitation, and the need for even more objective data on how well older patients do or do not respond to aggressive therapies becomes imperative.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only