September 25, 1995

The Unbearable Rightness of Bedside RationingPhysician Duties in a Climate of Cost Containment

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).

Arch Intern Med. 1995;155(17):1837-1842. doi:10.1001/archinte.1995.00430170025003

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