Thinking about cost – undermining trust

Abstract

SummaryThis commentary argues that decisions about the distribution of resources in a healthcare system paid out of taxation such as the NHS is best dealt with at arm's length from the doctor-patient encounter within the clinic. Thus, the role of the National Institute of Health and Clinical Excellent (NICE) that is to take a population perspective is appropriate, whereas any attempt by individual doctors to be influenced by costs and to base their judgements on the relative costs of interventions is likely to undermine the trust that exists within the doctor-patient relationship.