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Ethics Code Backs ‘Parsimonious’ Health Care

January 4, 2012
Written by: , Filed in: Medical Ethics, Practice Management
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Parsimonious: characterized by parsimony; miserly; close. Synonymn: stingy.

Parsimonious: 1. exhibiting or marked by parsimony; especially: frugal to the point of stinginess. 2. sparing, restrained. Synonym: see stingy.

Parsimonious: unwilling to spend money or use resources; stingy or frugal.

Parsimonious: very unwilling to spend money or use resources.

Those definitions come from, respectively, Webster’s New World College Dictionary, Fourth Edition; Merriam-Webster’s Collegiate Dictionary, Ninth Edition; the Oxford American Dictionaries “widget” dictionary built into my elderly Mac computer; and the Concise Oxford English Dictionary, Eleventh Edition.

Virginia Hood, MBBS, president of the American College of Physicians (ACP), disagrees with all of them.

“‘Parsimonious’ is a good word in the sense that it means that you use only what’s necessary,” she said, as quoted by Rob Stein of NPR News. “I don’t see a particular problem with that. Maybe it has some connotations where people think frugality or being parsimonious is the same as being mean or inadequate. But I don’t think that is the real meaning of that word.”

OK, so the ACP president would make a lousy lexicographer (“a writer of dictionaries; a harmless drudge,” as defined by the first famous one, Samuel Johnson).

So what?

Well, the new sixth edition of the American College of Physicians Ethics Manual, published Tuesday in Annals of Internal Medicine, includes this sentence:

Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.

Dr. Hood argues that the Ethics Manual simply reflects the reality that, as she told NPR, “The cost of health care in the United States is twice that of any other industrialized countries, and we are not providing care to as many people as they do in other places, and we don’t even have as good outcomes. So, given that, we really have to look at ways of doing things better.”

Most people probably agree with that last sentence. But those who receive “parsimonious” care are not likely to think of it as “doing things better.” Instead, as Daniel Callahan, PhD, of The Hastings Center, a bioethics research institution, told NPR:

If you say certain things will not be cost-effective, they’re not worth the money, well, that’s rationing, particularly if some patients might benefit or simply some might desire it. … So that’s where this all becomes a real viper’s pit.

The word “rationing” does not appear in the Ethics Manual. But it will definitely come up in debates about it—and in the wider and infinitely messier debate about controlling the costs of health care.

Is parsimony really the solution?

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Related seminar: The Business of Radiology

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