William L. Berger, MD
Potential Financial Conflicts of Interest: None disclosed.
Berger W.; Health Care Costs. Ann Intern Med. 2005;143:844. doi: 10.7326/0003-4819-143-11-200512060-00017
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Published: Ann Intern Med. 2005;143(11):844.
TO THE EDITOR:
“Doc, if you can't do a little better on that price, we'll just have to let Mama go.” Doesn't sound familiar, does it? It would if medicine were the 1-dimensional, market-driven enterprise that Dr. Bodenheimer presents (1). Clearly, there is a second dimension influencing health care decisions and utilization that is neither “market-driven” nor “rational.”
Anyone sorting through the estate of a loved one has encountered a 2-dimensional value system. Certainly, every item has a market value—that's why we have eBay. But many items also have a sentimental value that cannot be expressed in dollars. This second dimension of value is independent of, additive to, and often greater than the item's market value. This and other human values, such as the need to feel that the world is fair, safe, connected, and in control, define a dimension of nonmarket value that I broadly term spiritual. Unlike the market value of traded commodities, spiritual value cannot be bought, transferred, or even quantified, yet it still heavily influences decisions. As physicians, we are at times counselor, comforter, and conduit of hope. These are spiritual dimensions of our work.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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