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The Medical Professionalism Blog

Extremist Proposal Shocks the Medical Establishment

I suspect many were shocked, even disturbed, upon reading the article, Professionalism, the Invisible Hand, and a Necessary Reconfiguration of Medical Education by distinguished professor of medical education at Mayo Clinic, Fred Hafferty, and his two colleagues, Drs. Brennan and Pawlina. In the article, the authors call for all medical students to achieve competency in the economics of care prior to seeing their first patients. They state:

“There will be no traditional ‘patient care’ contact until students are fully able to decode and explain the highly cryptic billing statements that encumber patients. As students enter the bio-medical side of their training, patient meetings will begin to add explanations of diagnosis and treatment options to those of cost.”

Does this sentiment fly in the face of the professionalism’s commitment to the primacy of the patient? Or, does this radical notion of costs being taught prior to and during medical school provide a fresh way of thinking about medical education’s role in teaching about the Triple Aim that includes cost? Professor Hafferty challenged the status quo once before when he revealed the sociological construct of the hidden curriculum and a system approach to professionalism. Perhaps he’s doing so again…

HaffertyFred Hafferty

Is this merely the authors’ radical notion or is it aligned with what needs to happen if the nation is to prevent financial ruin? Given the cost of care and waste in the system, we need bold, new ways of thinking by physicians and thought leaders such as this.

Organizations such as CMS and Institute for Healthcare Improvement have called for a focus on the Triple Aim – outcomes of care, patient experience and affordability. Yet, most quality and safety departments in hospitals and medical groups focus more on eliminating unnecessary steps in a process rather than identifying inappropriate diagnostic tests or treatments. Thus the more fundamental question arises of what exactly “it” is that provides very little additional information or benefit in the quest for good medical care.

Dr. Steve Weinberger, Executive Vice-President of the American College of Physicians, calls for high–value, cost-conscious care as the seventh competency to be required by the Accreditation Council for Graduate Medical Education and specialty certifying boards. Identifying cost as a distinct component will send a strong signal and help generate the proper attention it needs.

So are these co-conspirators wacky agitators or have they suggested a bold new initiative?

5 Comments to Extremist Proposal Shocks the Medical Establishment

  • December 3, 2012 at 1:24 am | Permalink

    Back to basics again. No amount of new rules, revised training etc will effect the desired changes, Nothing will change in medicine, including defensive testing, until physicians learn to treat the patient with compassion and respect and listen to the patient and take an adequate history and physical. Physicians and non provider support staff are extremely deficient in all these skills. I know this as I am highly trained physician who happens to be a patient in my own subspecialty. You all focus on the wrong things to start with. Oh, I forgot lying/cover ups in the EMR is another problem not mentioned in these blogs. .

  • February 1, 2012 at 7:34 pm | Permalink

    Many medical students and residents want to know how much things cost but they can’t find out the answers since there is no transparency and everything is so cryptic. The irony here is that medical schools will need to recruit a health administrator from their hospital to teach students how to decipher a hospital bill! Lastly, as the hidden curriculum (as Dr. Hafferty knows well) is powerful! So any instruction will be undone by watching faculty who may encourage overtesting and overuse.

  • Ileana Balcu's Gravatar Ileana Balcu
    January 31, 2012 at 4:19 pm | Permalink

    I think the article is great, and the link is great, but why the need to use that title? You “suspect” they will be shocked and consider the proposal extremist, so just say so in the title as well or just skip the sensation and just praise the authors for well-timed and well-written article.

  • Ronni Sandroff's Gravatar Ronni Sandroff
    January 31, 2012 at 10:21 am | Permalink

    Great concept, but will we have to wait until a new generation of physicians dominates the healthcare workforce, or will those currently in practice also shift their emphasis?

  1. By on February 5, 2012 at 6:55 pm
  2. By on January 31, 2012 at 12:12 pm

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