Doctors Practicing Resource Stewardship

Healthcare consumes substantial financial resources and is responsible for massive amounts of carbon emissions. We are used to thinking that this is a result of policy, procurement, and patient care requirements within the healthcare system. However, the individual physician is in a unique position to influence decisions that impact how resources are used in healthcare. The American Medical Association (AMA) itself recognizes as much, and in its “Code of Medical Ethics” writes, “Physicians’ primary ethical obligation is to promote the well-being of individual patients. Physicians also have a long-recognized obligation to patients in general to promote public health and access to care. This obligation requires physicians to be prudent stewards of the shared societal resources with which they are entrusted. Managing health care resources responsibly for the benefit of all patients is compatible with physicians’ primary obligation to serve the interests of individual patients.” This means that in his/her clinical approach to an individual patient, the physician must not only think of the individual patient, but also of how his/her decision-making impacts the ability of the healthcare system to care for all patients and how decision-making (for example about what devices to use) impacts the environment.

The triple-aim of increased access, higher quality, and lower cost of care translates to the physician’s obligation to consider population health when treating the individual patient: “The relationship between professional decisions and cost concerns is not new. Until recently, physicians justified their clinical decisions in terms of personal value, the incorporation of patient needs and preferences, and technical value, the incorporation of evidence-based health outcomes of individuals and populations. The third component of allocative value, on the other hand, brings considerations of individual patient needs and the needs of the entire population together and reconfigures professionals’ accountability from patient’s advocate towards balancing a duty to society with a duty to the individual patient.” Allocative value must be balanced with the physician’s moral duty to provide care for individual patients.

 

Allocative value must be balanced with the physician’s moral duty to provide care for individual patients.

 

The issue of physician resource stewardship surfaced most clearly during the pandemic, where PPE shortages, backorders, etc. highlighted the fragility of a healthcare system that was used to consumption without limitations. While hospitals and their purchasing departments were tasked with ensuring supplies of scarce materials and devices, “proponents of a physician-in-the-lead approach for resource stewardship argue that physicians are qualified to guide resource steward efforts because they have a better understanding of health-related decisions and their consequences compared to non-clinical actors.” I believe the pandemic has started a stronger focus on physician resource stewardship than we have seen before, and physician leaders in areas strongest impacted by the pandemic are pushing the topic. In “Guidance for Cardiac Electrophysiology During the Coronavirus (COVID-19) Pandemic from the Heart Rhythm Society COVID-19 Task Force”, the authors noted that “Electrophysiologists play an important role in cardiovascular health, with more than 40% of cardiology encounters being arrhythmia-related” – and honed in on – among other things – resource stewardship.

Heart Rhythm Society 2024 - the annual meeting of physicians, manufacturers, and administrators in electrophysiology will take place in Boston, May 16-19. I believe that electrophysiologists are increasingly aware that they need to play a role in reducing the cost of electrophysiology procedures in order to deliver the patient care impact they want. At the same time, they are becoming increasingly sensitive to the impact the relentless adoption of new single-use device technology has on the environment. I believe they are truly adopting a sense of resource stewardship that is badly needed in electrophysiology today. And I am hopeful that Heart Rhythm Society’s conference will reflect this.

 

...they are truly adopting a sense of resource stewardship that is badly needed in electrophysiology today.

 

Historically, the electrophysiologist went to the Heart Rhythm Society conference to learn about new technologies from the medical technology manufacturers. And this year, again, we will see manufacturers launching new technologies that are more advanced than last year’s technologies. This used to be enough. However, this year, manufacturers may meet with a different kind of electrophysiologist – a physician who will ask new types of questions, such as: Do studies support that this new technology is better in terms of patient outcome or operational efficiency? Are the marginal improvements in functionality presented actually worth the extra costs? Or can I continue using last generation technology that produce results that are just as good? Does the use of this technology enhance patient access? What is the carbon emissions footprint of the new technology? Is there a Lifecycle Analysis available that shows carbon emissions over the life of the device? Are there ways available to reduce the carbon emissions footprint, such as reprocessing or other forms of re-use?

New technology is an important cost factor in healthcare, and studies have shown that it is – in large part – physician preference for new and expensive technology that drives the increase in device costs. We will focus our dialogue at Heart Rhythm Society 2024 on resource stewardship, its combined financial and environmental benefits, and the role the physician plays in this.

 

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