The Unbearable Rightness of Bedside Rationing: Physician Duties in a Climate of Cost Containment

doi:10.1001/archinte.1995.00430170025003

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Vol. 155 No. 17, 25 SEPTEMBER 1995

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The Unbearable Rightness of Bedside Rationing

Physician Duties in a Climate of Cost Containment

Peter A. Ubel, MD; Robert M. Arnold, MD

Arch Intern Med. 1995;155(17):1837-1842.

Abstract

A local internist is in the process of ordering an intravenouspyelogram for a patient she suspects of having kidney problems,when a medical student shadowing her in clinic interrupts. Thestudent wants to know why the physician is not ordering a low-osmolalitycontrast agent for the patient, having read that they are lesslikely to cause serious side effects than high-osmolality contrastagents. The physician realizes that the medical student is correct,but rejects the suggestion, telling the student that "low-osmolalitycontrast agents are the standard of care for low-risk patients."

Author Affiliations

From the Veterans Affairs Medical Center, the Division of General Internal Medicine, the Center for Bioethics, and the Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia (Dr Ubel), and the Division of General Internal Medicine and the Center for Medical Ethics, University of Pittsburgh (Pa) (Dr Arnold).

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