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Health Care Has The Potential To Include Mandated Rather Than Recommended Treatment Guidelines
Writing in the Aug. 6 edition of the New England Journal of Medicine, they warn that the trends like the humanism movement that focuses on individual values, goals and preferences, and the move toward evidence-based practice, data and guidelines are standardized therapies and procedures.
As President Obama and Congress weigh changes in the nation's health care system they must avoid creating a system where physicians are financially motivated to pressure patients into mandated treatments that conflict with their values and needs, two Beth Israel Deaconess Medical Center physicians warn.
In particular, they raise concern over the potential to include mandated rather than recommended treatment guidelines as part of Medicare reforms. Mandated treatments have been proposed as part of "value-based purchasing" and "pay for performance."
"These guidelines will have the unintended consequence of misaligning the goals of doctors and patients," they write. "Physicians will face a new conflict-of-interest: they will be financially motivated to pressure patients into accepting a mandated treatment regardless of whether it is compatible with their values or preferences or to avoid caring for patients who refuse the mandated treatment."
Not only are there serious ethical concerns about mandated guidelines, but also significant scientific limitations to this approach to treatment. "Because guidelines are derived from clinical studies carried out in selected groups of patients and their statistical conclusions are based on study populations, they may not apply to an individual patient, especially if he or she has coexisting conditions."
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