The report's authors acknowledge that “arguments that physicians should never allow considerations other than the welfare of the patient before them to influence their professional recommendations and treatment do not mesh with the reality of clinical practice.”
The meeting's reference committee on constitution and bylaws recommended the report's adoption, writing that “the report puts patients first and strikes an appropriate balance between considering patient interests and healthcare resources on a larger scale.”
Speaking for the Florida delegation, Dr. David McKalip said that although the report had been before the House four times, he didn't think that the council had it right yet. He moved to refer it back for more work. McKalip also said it was becoming a divisive issue and added that the promotion of resource stewardship could lead to patient mistrust and patient belief that physicians were holding back from doing all they could to help patients.
The president of the American Academy of Family Physicians, Dr. Glen Stream of Washington state, disagreed.
“We do believe they got it right,” Stream said. The reality, he said, is that resources are limited.
Dr. William Golden with the American College of Physicians agreed with Stream, but Dr. William Gee of Kentucky, representing the American Urological Association, did not. Dr. Pino Colone, an emergency physician from Michigan, also spoke for referral, and Dr. Joseph Maldonado, a urologist from New York, said stewardship was important, but had to be “subservient to the patient before us.”
The physicians ultimately voted 257-202 (56% to 44%) against referring the report back for additional work. The report was then subsequently adopted via voice vote.
The report concludes with recommendations that physicians “choose the course of action that requires fewer resources when alternative courses of action offer similar likelihood and degree of anticipated benefit compared to anticipated harm for the individual patient, but require different levels of resources.” It also, however, calls on doctors to “be transparent about alternatives, including disclosing when resource constraints play a role in decision-making.”