As a future physician, you’ll be pulled in many directions. Your medical skills will be tested, you’ll need to think on your feet, and you’ll need to make decisions that will affect your patients’ well-being and health outcomes. But how will you know whether you’re making the right decisions?
To be a successful physician in practice, you’ll need to not only master clinical skills but also embrace a challenging science that only recently began making its way into physician training.
The imperative to deliver high-value care
Physician training—as well as the practice of medicine—traditionally has focused on putting the best interest of the patient foremost by doing everything possible for each individual patient. But more recently, the medical profession has come to recognize that doing everything medically possible isn’t always in the patient’s best interest.
At the same time, physicians have an ethical obligation to be prudent stewards of health care resources. That means that future physicians must learn how to deliver high-value care that achieves good patient outcomes at a reasonable cost—and simultaneously upholds the primacy of the patient-physician relationship.
Think this sounds nuanced and challenging? That’s because it is.
Even physicians like myself, who have been practicing and teaching for decades, can feel like we’re being pulled in so many directions that making the optimal decision for every scenario can be very difficult. First, we must evaluate the particular needs of the patient sitting right in front of us. We also must consider whether our decision would change if we were to apply it to the whole population of people who present with that medical problem.
Then there are the institutional and financial considerations. Will the patient’s insurance company cover the tests or treatments? What about the clinical setting? If the patient is in the hospital, some immediate expenses can save money in the long term, while ordering similar tests or procedures in an outpatient setting might have just the opposite result.
On top of that is the fear of medical liability that leads to what is known as “defensive medicine,” in which physicians order more than they might think is medically necessary to cover all their bases.
But with estimates in the hundreds of billions of dollars when it comes to annual expenditures on unneeded or unwanted health care in the United States, physician stewardship is more important now than ever.
Learning how to be a prudent physician steward
Some medical schools and residency programs are building into their curricula programs that equip physicians in training to rise to the challenge of providing high-value care.
For instance, one of the main themes in the AMA’s Accelerating Change in Medical Education Consortium, which now consists of 32 medical schools around the country, is adding a new “third science” to the core of physician training. “Health care delivery science,” or “health systems science,” consists of a number of practical elements that prepare students for the modern health care environment. These include health policy and economics, population and public health, and value-based care, among other very timely topics.
Schools in the consortium are working together to rapidly disseminate best practices from their curriculum innovations to medical schools around the country. So if you find yourself in a position to participate in similar training at your institution, take full advantage of it. Learning how to navigate these issues from experienced physicians is invaluable.
Additionally, one excellent way that every physician in training can further explore what it means to deliver high-value care is through the November 2015 issue of the AMA Journal of Ethics. Created with students and residents in mind, the journal offers perspectives that get to the heart of the matter.
In particular, these pieces are fantastic resources for physicians in training:
- “Teaching high-value care” describes several programs that are not only teaching medical students how to be physician stewards but are empowering students to be change agents in this area.
- “Cost-consciousness in teaching hospitals” takes a look at some of the elements of clinical training that may need to change to better prepare trainees for delivering high-value care.
- “Countering medicine’s culture of more” explains how one physician turned his experience as a resident on its head as he trains future physicians to understand clinical overuse and patient harm.
- The AMA Code of Medical Ethics’ opinion on physician stewardship, a fairly recent addition to the oldest of professional ethical codes, details how physicians should fulfill their obligation as prudent stewards of health care resources and outlines the greater system changes that are needed to foster high-value care.
Physician stewardship isn’t a theoretical concept. It’s an essential part of the practice of medicine in the 21st century. Take every opportunity to make sure you’re prepared to deliver the high-value care that will lead to the best health outcomes for our patients.
