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British Medical Bulletin 51:842-853 (1995)
© 1995 The British Council

research-article

The doctor's dilemma

D H Irvine and L J Donaldson

Regional Adviser in General Practice, Postgraduate Institute for Medicine and Dentistry, Division for General Practice II Framilington Place, Newcastle upon Tyne NE2 4AB, UK
Regional General Manager and Director of Public Health, Northern and Yorkshire Regional Health Authority and Professor of Applied Epidemiology, University of Newcastle upon Tyne UK

Abstract

The close relationship between expenditure on health care and the countless individual judgements made by doctors for their patients means that any discussion about rationing must involve the process of clinical decision-making. Increasingly, doctors are being drawn into rationing by two powerful forces. Firstly, through the corporate responsibilities of those working within a managed health care system in which organisational objectives and budgetary constraints are agreed and specified in a much more explicit way than ever before. Secondly, by the professionally-led movement towards more clinically effective practice. These, in combination, are leading towards a fundamental review of the nature and ethical basis of clinical practice in which the duty of doctors to individual patients must be balanced against the wider considerations.


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