THE UNBEARABLE RIGHTNESS OF BEDSIDE RATIONING - PHYSICIAN DUTIES IN A CLIMATE OF COST-CONTAINMENT

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.''