Medical Ethicists Urge Caution in Teaching High Value Care

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Press Release
December 6, 2016
For Immediate Release

Medical Ethicists Urge Caution in Teaching High Value Care

Calling for an “unwavering focus on the primacy of patient welfare,” a pair of medical ethics scholars urges careful consideration of how the concept of high-value care (HVC) should be integrated in medical education.

The JAMA Viewpoint published December 6 states, “if primacy of patient welfare is to truly remain fundamental to the profession, instilling commitment to this principle should be the most critical ethical value instilled in cultivating professional identity.”

If ‘value’ is considered the ratio of health benefits achieved per unit of cost, value can be increased in several ways: increasing health benefits, decreasing costs, or accepting less health benefit as a trade-off for cost savings.

Teaching approaches that over-emphasize cost savings “could risk causing trainees to lose sight of individual patient welfare or create unintended consequences for subsequent bedside decision-making,” write Viewpoint authors Matthew DeCamp, MD PhD, and Kevin Riggs, MD, MPH.

“Physicians must sometimes balance ethical tension between cost-saving and patient welfare. The best way to do this is unsettled among ethics scholars and practicing physicians. This lack of consensus could lead to inexperienced medical trainees misunderstanding their duty,” says DeCamp, assistant professor at the Johns Hopkins Berman Institute of Bioethics and Division of General Internal Medicine.

The consequences could be damaging to both the physician-patient relationship and the profession, the authors say. “[A]mbiguity regarding the primacy of patient welfare in HVC education risks patient distrust and societal backlash against what might be perceived as training future physicians to control costs at the expense of patient welfare.”

The authors do believe that the concept of value can be ethically introduced in medical education, but the distinct perspectives of patients, organizations, and society must be included, and how value is taught may need to be tailored to medical trainees’ level of experience.

“Early on, it may be more appropriate to focus on teaching medical students to communicate about costs with patients. Later, more complex concepts of value could be introduced, DeCamp says. “This is much the same way we teach in other areas of medicine – blood draws first, heart catheterizations later.”

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JAMA Viewpoint: “Navigating Ethical Tensions in High-Value Care Education”
JAMA. 2016;316(21):2189-2190. doi:10.1001/jama.2016.17488

Dr. Riggs’ work on this manuscript was supported by National Institutes of Health grant T32HL00718

About the Johns Hopkins Berman Institute of Bioethics
One of the largest bioethics centers in the world, the Johns Hopkins Berman Institute of Bioethics is the home for collaborative scholarship and teaching on the ethics of clinical practice, public health and biomedical science at Johns Hopkins University. Since 1995, the Institute has worked with governmental agencies, nongovernmental and private sector organizations to address and resolve ethical issues. Institute faculty members represent diverse disciplines including medicine, nursing, law, philosophy, public health and the social sciences. More information is available at



Heidi Holtz

Heidi Holtz is a Hecht-Levi Fellow at the Berman Institute of Bioethics and a Research Scholar at Johns Hopkins Hospital.  Heidi received her PhD in Nursing Science at Indiana University.  As a PhD student, Heidi developed a program of research on nursing students’ experiences and consequences of faculty incivility.  Incivility in nursing, medicine, education, and clinical practice create critical ethical dilemmas that affect communication, trust, mental and physical well-being, and damage the culture of safety for patients and clinicians.  During her Hecht-Levi Fellowship, Heidi’s goal is to contribute to the development of interventions and policies to reduce and/or prevent the frequency of moral distress and burnout amongst healthcare providers.  Heidi has a special interest in researching the construct of moral resilience and applying that research to develop innovative approaches to foster moral resilience in healthcare environments.

Katherine Heinze

Katherine Heinze received her PhD in Nursing from the Johns Hopkins School of Nursing in August 2016.  Prior to her graduate studies, she worked as a nurse in the pediatric oncology and bone marrow transplant department at the Johns Hopkins Hospital, an experience which motivated her dissertation research:  “Parent and Family Responses to a Child Undergoing BMT during Transitions in Care.” During her H-L Fellowship, she will continue to study families with children who have serious illnesses, with an emphasis on palliative care and bioethics. She also is interested in investigating the moral distress that healthcare providers experience in ethically challenging contexts. Her personal research mission is to reduce suffering in seriously ill children, their family members, and the healthcare providers who care for them.

Angie Boyce

Angie Boyce is a Research Scholar at the Johns Hopkins University (JHU) Berman Institute of Bioethics. She is also the Project Director of the JHU Center for Bridging Infectious Disease, Genomics, and Society (BRIDGES), an NIH-funded Center of Excellence in Ethical, Legal, and Social Implications (ELSI) of Genetics Research. She received her AB in History and Science from Harvard College in 2003, and completed her PhD in 2014 at Cornell University in the Department of Science & Technology Studies, supported by the National Science Foundation Graduate Research Fellowship Program. From 2014-2016, she was a Robert Wood Johnson Foundation Health and Society Scholar at the Harvard T.H. Chan School of Public Health. Her research interests include: ethical issues in infectious disease (especially related to containment care, outbreak management, and antimicrobial resistance); regulatory politics, inter-agency collaboration, and consumer advocacy; and translating genomics into population health benefit.