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Arch Intern Med. 1995 Sep 25;155(17):1837-42.

The unbearable rightness of bedside rationing. Physician duties in a climate of cost containment.

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Veterans Affairs Medical Center, Philadelphia, Pa.


A local internist is in the process of ordering an intravenous pyelogram for a patient she suspects of having kidney problems, when a medical student shadowing her in clinic interrupts. The student wants to know why the physician is not ordering a low-osmolality contrast agent for the patient, having read that they are less likely to cause serious side effects than high-osmolality contrast agents. The physician realizes that the medical student is correct, but rejects the suggestion, telling the student that "low-osmolality contrast agents are the standard of care for low-risk patients."

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