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Navigating Ethical Tensions in High-Value Care Education

ARTICLE: Navigating Ethical Tensions in High-Value Care Education

AUTHORS: Matthew DeCamp and Kevin R. Riggs

JOURNAL: JAMA. 2016 Dec 6;316(21):2189-2190. doi: 10.1001/jama.2016.17488.

Enthusiasm for high-value care is increasing throughout health care, including in the education of medical students, residents, and fellows.1 Until recently, there were few examples of educational programs that equipped future physicians with the tools required to practice high-value care or even consider the cost of care they deliver. In fact, future physicians were encouraged to provide care that could be considered as quite the opposite—academia often instilled excess over restraint, celebrating trainees who generated (and tested for) the broadest differential diagnosis. Because physicians who train in high-spending regions subsequently provide more costly care than those who train in low-spending ones,2 medical school and residency are critical times to teach high-value care.

Despite the enthusiasm, inherent to the concept of value are potential ethical tensions between patient and societal interests, and different approaches to increasing value may be controversial. In this Viewpoint, we describe this tension in the context of high-value care education and suggest that physicians’ primary commitment to patient welfare and the process of professional identity formation that cultivates this commitment may require certain limits to high-value care education. However, these limits can be implemented without sacrificing the benefits of equipping future physicians to practice high-value care.

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Kelsey Bennett