title: The unbearable rightness of bedside rationing. Physician duties in a climate of cost containment.
abstract: 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."
authors.affiliation: Veterans Affairs Medical Center, Philadelphia, Pa.
authors.forename: P A
authors.initials: PA
authors.lastname: Ubel
authors.forename: R M
authors.initials: RM
authors.lastname: Arnold
mesh_terms: D003220:Conflict, Psychological; D003363:Cost Control / Q000191:economics / Q000331:legislation & jurisprudence; D003362:Cost-Benefit Analysis / Q000191:economics / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D015276:Health Care Rationing / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000331:legislation & jurisprudence; D040841:Resource Allocation; D035502:Trust; D014481:United States; D035862:Vulnerable Populations; D028761:Withholding Treatment