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15 Jun 2015

By Dr Michael Gannon

When it comes to managing health care resources, doctors must balance their primary ethical obligation to care for the patient with their secondary obligation to use health care resources wisely.

At times, these obligations may conflict – but focussing on stewardship allows doctors to find an equitable and realistic balance between the needs of the patient and the need for the wider community to keep health care affordable.

The essence of stewardship is avoiding waste - it is not about denying care based on scarcity of resources, otherwise known as rationing.

How do we become effective stewards of health care and avoid waste without being seen to ration care?

How do we deal with health care administrators, third party payers and governments who place unreasonable constraints on our ability to make treatment recommendations based on our patients’ health care needs, rather than the cost of care?

How do we manage patients (and family members) who make unreasonable health care demands, requesting treatments that are simply ineffective or inappropriate for their health care needs?

And what about the ever present fear of litigation – isn’t ‘defensive medicine’ the best way to practice?

At this year’s AMA National Conference, I chaired a policy session on stewardship, Waste Not, Want Not: Ethics, Stewardship and Patient Care.

The purpose was to assist doctors to become better stewards of our health care resources through learning how to:

  • identify the medico-legal challenges to effective stewardship;
  • communicate with patients about resource use; and
  • participate in initiatives that identify and discourage ineffective care at the institutional level, as well as in the wider community.

The session’s presenters, Dr Ian Scott, Dr Sara Bird and Dr Lynn Weekes, were truly engaging.

Dr Scott, Director of the Department of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital in Brisbane, outlined 10 clinician-led strategies to maximise value in Australian health care.

Dr Bird, Manager of the Medico-Legal and Advisory Services of MDA National, provided a medico-legal perspective on stewardship in relation to the practice of defensive medicine.

Dr Weekes, the CEO of NPSMedicineWise, presented the ChoosingWiselyAustralia campaign, whose goal is to enhance quality care by reducing unnecessary care.

We are truly indebted to our presenters and appreciate the time they took to engage with our delegates during a lively question and answer session following their presentations.

The AMA’s job now is to develop a policy on ethics and stewardship to assist our advocacy.

We want to ensure there is a culture of stewardship within the medical profession.

This clearly begins at medical school and continues throughout a doctor’s career with continuing professional development.

Doctors need to be informed of the cost of treatments and procedures, and be guided in making responsible treatment recommendations that balance efficiency with the primacy of patient care.

We also need to ensure that any system-level initiatives to reduce wastage involve the profession, and do not compromise our professional judgement and clinical independence to act in the best interests of individual patients and advocate for the wider public health. 

I strongly encourage all members to visit the AMA website and view the presentations, along with the question and answer session from the policy discussion session Waste Not, Want Not: Ethics, Stewardship and Patient Care. They can be viewed at


Published: 15 Jun 2015