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Rationing, Justice, and the American Physician

William A. Knaus, MD
JAMA. 1986;255(9):1176-1177. doi:10.1001/jama.1986.03370090098031.
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There are two articles in this week's issue of The Journal that address the important question of what happens when demand for sophisticated medical services, in this case intensive care treatment, exceeds supply.

If you haven't already done so, read the article by Strauss et al1 first. These investigators were able to cleverly relate the number of available intensive care unit (ICU) beds to physicians' admitting and discharge decisions by matching the number of open beds to the characteristics of patients admitted. What happened when there were few or no empty beds? Medical and surgical patients who were not very ill—for example, patients with chest pain but with a low probability of having a myocardial infarction—the "too healthy," were excluded.

This study is the first to directly link daily variations in ICU bed availability to physicians' decision making. Its theme, however, is one that I increasingly hear during conferences


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