Editor’s Choice: It’s the patients, stupid

In October 1992 three phrases were listed on a sign in the headquarters of the team leading Bill Clinton’s US presidential campaign: “Change vs more of the same. The economy, stupid. Don’t forget health care.”

The second of those phrases became the de facto slogan for Clinton’s 1992 campaign. It is now shorthand both for the key role of financial solvency in allowing society to achieve its higher aims and for the need to identify and focus on the core element of an issue. Those two points are central to the argument that Dare Oladokun makes this week for more doctors to learn about health economics http://careers.bmj.com/careers/advice/Is_there_an_economist_in_the_house%3F.

Oladokun argues that, because the health service has limited resources with which to treat patients, doctors need to understand the impact that their treatment choices will have on available resources. “Clinicians often have to choose between competing interventions for disease management,” he says. “Choosing the most effective interventions—regardless of ‘value for money’—will ultimately lead to the exhaustion of resources.”

But he points out that patients, not just economics, must also be at the centre of doctors’ thinking. “Conversely, basing these decisions on cost alone is also wrong—doing nothing is often the cheapest option.”

A better understanding of health economics would help doctors balance these competing demands, he believes. “The ability to perform economic evaluations, or at least critically evaluate health economic evidence, can be invaluable for decision making,” he says. “Clinicians with knowledge of health economics can help to provide a balance between the human aspect of healthcare and the empirical nature of economics.”