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."
Ubel PA, Arnold RM. The Unbearable Rightness of Bedside RationingPhysician Duties in a Climate of Cost Containment. Arch Intern Med. 1995;155(17):1837-1842. doi:10.1001/archinte.1995.00430170025003