The unbearable rightness of bedside rationing. Physician duties in a climate of cost containment

Arch Intern Med. 1995 Sep 25;155(17):1837-42.


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."

MeSH terms

  • Conflict, Psychological*
  • Cost Control* / economics
  • Cost Control* / legislation & jurisprudence
  • Cost-Benefit Analysis / economics
  • Cost-Benefit Analysis / legislation & jurisprudence
  • Ethics, Medical
  • Health Care Rationing* / economics
  • Health Care Rationing* / legislation & jurisprudence
  • Humans
  • Practice Patterns, Physicians'* / economics
  • Practice Patterns, Physicians'* / legislation & jurisprudence
  • Resource Allocation*
  • Trust
  • United States
  • Vulnerable Populations
  • Withholding Treatment