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To the Editor: In their Commentary, Drs Wharam and Sulmasy¹ note that "[p]atients also affect resource use," and "patients are not ethically justified in demanding that health systems ‘do everything’ to facilitate their individual health care preferences." In a table, the authors list the obligations of various groups. However, the obligation to help patients learn about their effect on resource use and the ethical nature of their demands is not included in that table.

This task often falls to the physician at the time of hospitalization, a time when the patient and family might not be able to comprehend the discussion. Physicians need help from political leaders and health care institutions in educating the public about these issues before the time of admission and serious illness.

Financial Disclosures: None reported.

Steve G. Hubbard, MD
steve_hubbard@eamc.org
East Alabama Medical Center
Opelika, Alabama

1. Wharam JF, Sulmasy D. Improving the quality of health care: who is responsible for what? JAMA. 2009;301(2):215-217. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;301(19):1990.

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Improving the Quality of Health Care: Who Is Responsible for What?
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