Physician stewardship of healthcare resources

Stewardship may be defined as the judicious management of resources that others entrust to one's care. Physicians are entrusted with decision-making authority in health care; decision making that often draws on pooled community resources, whether through private insurance or government programs. Physicians' roles and responsibilities in stewardship are a matter of intense and pressing concern for professional organizations, physicians, policy makers and patients. Most agree that physicians should play a leadership role in controlling costs through, for instance, identifying unnecessary services and developing evidence based practice guidelines. The proper role for physicians as stewards when caring for individual patients "at the bedside," however, remains in dispute. Knowledge of clinical alternatives and of patients' preferences and needs enable physicians to individualize recommendations and minimize harms, unlike decision-makers who are more distant from the bedside. On the other hand, allocation decisions should be transparent and open to critique, and limits on individual patient advocacy could undermine trust. This presentation will first describe and justify existing professional norms and values related to stewardship. Second, it will review existing empirical research on doctors' knowledge, attitudes and behaviors related to practicing within resource constraints and analyze how that evidence compares to existing professional ethical norms and values. Finally, questions will be posed to the attendees about professional ethics, trust and stewardship.