Rather, it suggests "that in the face of this new and uncertain moment in the reform of the healthcare system, physicians are lapsing into the well-known, cautious instinctual approaches humans adopt whenever confronted by uncertainty: blame others and persevere with 'business as usual.' "
"Indeed," they continued, "only employers and physicians' professional societies were reported to bear less responsibility than the individual practitioner. This is a denial of responsibility… Can they really be both captain of the healthcare ship and cede responsibility for cost control to almost everyone else?"
Tilburt says that he thinks that as a society, "we're reaching a point where these kinds of 'I don't know (what it costs) responses aren't going to fly anymore. The belt tightening of the economy has everybody thinking about price and making everybody more price-sensitive.
That's tough, and gets into a muddy ethical area doctors call "dual-agency," in which the physician is called upon to look at both sides of the issue, from the patients perspective and society's.
"There will be a lot of questions on how to do this best. If we're going to expect physicians to uphold the best interests of patients, and at the same time do a lot of dirty work on behalf of society to keep costs down, we have to give doctors the vocabulary to do that with integrity."
However, he says, this doesn't have to undermine patient-centered nature of their obligations.
"The profession and healthcare institutions are finally at the point where they are ready to say, 'Look, there's no reason why we can't put cost information in front of patients and doctors in a clinical interaction.' It's material information."