Virtual Mentor

Virtual Mentor. November 2012, Volume 14, Number 11: 821-923.

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November 2012 Contents

Improving Allocation of Limited Resources

Ethics Poll

Physicians for a National Health Program think that the U.S. should adopt single-payer national health insurance, a system in which a single public agency pays for health care, but delivery of care remains largely private []. Do you think single-payer insurance is the best way to pay for health care in the U.S.?
Don't know.

Many believe that the cost of medical school and the debt most graduates incur drives the majority of them to pursue training in lucrative subspecialties, thus contributing to the shortage of primary care physicians in the U.S. As a solution, Drs. Peter B. Bach and Robert Kochner propose making medical school free. Instead of paying for school, those who pursued highly specialized training would receive no stipend during their residency, while those who pursued training in primary care fields would receive the stipend that residents now get, about $50,000 a year. The forgone stipends of the many in specialty training would finance medical school for all. Which of the following best expresses what you think of this plan?
It's worth a try.
Don't try it; it wouldn't work.
Don't try it; it's unfair.
Don't know.

In allocating limited medical resources, the cost-effectiveness of a treatment is often assessed in terms of "quality-adjusted life-years" or QALYs. QALYs are the number of years of improved quality of life a person can expect to gain from a particular intervention. Who should participate in assessing the improvement in quality of life an intervention confers on people with a specific chronic condition?
Only those who have that chronic condition.
Only physicians who have treated many people with the condition.
Both those who have the disease and physicians who treat it.
Panels with those who have the disease, physicians who treat it, and representatives from those who pay for the intervention, e.g., Medicaid, Medicare, private insurers.
Don't know.


From the Editor

Accountability in Rationing
Adam Aronson
Full Text | PDF
Virtual Mentor. 2012; 14:823-824.

Educating for Professionalism

Ethics Cases

Surgery for Placebo Effect?
Commentary by C. Ronald MacKenzie, Matthew J. Matava, and Charles Carroll IV
Full Text | PDF
Virtual Mentor. 2012; 14:825-834.

Patient Self-Rationing, a Health System Problem
Commentary by Katherine J. Mathews
Full Text | PDF
Virtual Mentor. 2012; 14:835-838.

Is Understaffing a Unit a Form of Rationing Care?
Commentary by Narayan P. Iyer and Sabine Iben
Full Text | PDF
Virtual Mentor. 2012; 14:839-844.

Medical Education

The Family Medicine Accelerated Track Model: Producing More Family Doctors Faster
Betsy Goebel Jones and Steven L. Berk
Full Text | PDF
Virtual Mentor. 2012; 14:845-853.

The Code Says

The AMA Code of Medical Ethics’ Opinions on Cost Containment, Payment Structures, and Financial Incentives
Full Text | PDF
Virtual Mentor. 2012; 14:854-860.

Journal Discussion

The Inconclusive Evidence on CT Screening for Lung Cancer
David S. Gierada and Lawrence M. Kotner, Jr
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Virtual Mentor. 2012; 14:861-867.

State of the Art and Science

Cancer Gene Sequencing: Ethical Challenges and Promises
Siddhartha Devarakonda, Ramaswamy Govindan, and Peter S. Hammerman
Full Text | PDF
Virtual Mentor. 2012; 14:868-872.

Law, Policy, and Society

Health Law

The Constitutionality of the Affordable Care Act: An Update
Valarie Blake
Full Text | PDF
Virtual Mentor. 2012; 14:873-876.

Policy Forum

National Quality Forum Guidelines for Comparing Outcomes and Resource Use
Kevin D. Frick
Full Text | PDF
Virtual Mentor. 2012; 14:877-879.

Improving Health Outcomes and Promoting Stewardship of Resources: ABIM Foundation’s Choosing Wisely Campaign
Todd Ferguson
Full Text | PDF
Virtual Mentor. 2012; 14:880-884.

Medicine and Society

Power, Politics, and Health Spending Priorities
Michael K. Gusmano
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Virtual Mentor. 2012; 14:885-889.

History, Art, and Narrative

History of Medicine

God Panels and the History of Hemodialysis in America: A Cautionary Tale
Will Ross
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Virtual Mentor. 2012; 14:890-896.

Op-Ed and Correspondence


A Single-Payer System Would Reduce U.S. Health Care Costs
Ed Weisbart
Full Text | PDF
Virtual Mentor. 2012; 14:897-903.


Suggested Readings and Resources
Virtual Mentor. 2012; 14:904-920.

About the Contributors
Full Text | PDF
Virtual Mentor. 2012; 14:921-923.