Virtual Mentor. May 2008

This month in Virtual Mentor

System Constraints on Optimal Care

Health care systems operate at many levels and take many forms: hospital risk management policies, insurance company coverage determinations, Medicaid and Medicare reimbursement rules, the medical malpractice system, federal regulation of physician business practices, and national health association policies. This issue of Virtual Mentor looks at how these systems—essential to the delivery of health care in the 21st century—affect the day-to-day practice of medicine and how physicians manage the unintended consequences of systems that sometimes constrain good patient care.

Optimizing Medical Care with the Support and Limitations of Health Care Systems Laura Sigman, JD

Systems impact patient care when doctors must balance what is medically optimal with the limits of the systems in which they function.

Physician's Accountability for System Failure Commentary by David Lovinger, MD Dr. Jones has a duty to determine how the test results were lost and why, disclose this information to his patient, Mrs. Taylor, and see that she is not held responsible for the costs of rerunning the test.

Medicare's "Never-Event" Initiative Jared Hossack, MD, MBA Medicare will not pay for treatment of 8 preventable, hospital-acquired conditions (e.g., object left in place during surgery, catheter-associated urinary tract infection) that were not present when the patient was admitted.

Equity in Medical Care: An Aristotelian Defense of Imperfect Rules—and Bending Them Geoffrey Rees, PhD At their best, good systems allow space for the practical judgment of health care professionals to achieve justice in the particular actions of their daily practice.

Upcoming Issues

June: Quality of Life and Geriatric Patients
July: Gender-Based Medicine
August: Establishing the Boundaries of Informed Consent
September: Ethical Issues in Sleep Medicine

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