The Boston Globe had an article last month about how more expensive practices seem to persist even when the science doesn’t support it, and they use a study in my field to illustrate it. They attribute the lack of change on the part of physicians to reimbursement patterns. They recommend best practice committees with an eye toward withholding reimbursement for procedures deemed no more effective than conservative medical management.

Now, anyone who has been following my blog knows that I’m sympathetic to encouraging changes in practice patterns that are resource wasteful. I’ve proposed an approach in previous posts that I think could be self-correcting, rather than punitive. But it’s also important to re-emphasize that practice patterns are not just reimbursement-driven, but influenced by patient expectations and litigation as well. Examples of the former are fetal monitoring and the abandonment of silicone breast implants. Science only goes so far, as I’ve previously discussed.

In our zeal to curb unnecessary procedures and expenses, a laudable and necessary goal, we must also make sure that we protect the physician’s ability to use good judgment when special circumstances arise. Guidelines are good, but they are just that, and each patient is unique and requires a considered and individual treatment plan. I just hope that when the committees convene, they’ll consider this as well.


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