is a family practice doctor with a steady, yet varied, patient population. Practicing medicine in a small suburban community, he sees whole families ranging from newborn babies to adults well into their 80s. He prides himself on his practice of preventive medicine in particular, and, because he has such a longstanding rapport with his patients, they adhere to his counseling on healthy living and follow up regularly for annual physicals and appropriate screening tests. Among other things, Dr. Jorgensen is particularly diligent in his screening for, and treatment of, diabetes mellitus; he tests all of his patients over age 45 for diabetes and refers all of his diagnosed diabetic patients for annual ophthalmologic exams. Recently, Dr. Jorgensen began mentoring a new family practice physician, Dr. Sandkey. Dr. Sandkey completed her residency in family practice at a large, innercity academic hospital, where she attended a number of lectures on cost-effective treatment. Like Dr. Jorgensen, Dr. Sandkey has a special interest in preventive medicine and is well-versed in the current recommendations regarding diabetes screening and treatment.Because Dr. Sandkey is looking to model her practice after Dr. Jorgensen's, she has been going through old patient charts to see how Dr. Jorgensen tracks his patients' health maintenance. One day she approaches Dr. Jorgensen to discuss his screening practices: "Dr. Jorgensen, I have to ask you about how you choose your medical interventions and screenings. I read a study that indicated screening everyone age 45 and older for diabetes had minimal benefit but cost more than $500 per person on average. Why have you decided to screen this entire group of patients?" Commentary "The human condition is such that…there are many possible courses of actions and forms of life worth living, and therefore to choose between them is part of being rational or capable of moral judgment; [we] cannot avoid choice for one central reason...namely that ends collide; that one cannot have everything....The very concept of an ideal life...is not merely utopian, but incoherent." Isaiah Berlin [1] Dr. Jorgenson is imbued with a sense of obligation to his patients that transcends matters of cost. He wants to serve them well within a society that can seem frivolous
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