We practise in a world of limited resources. Because most of the decisions doctors make affect health expenditure, we must think cost effectively, even about individual patients. The inherent conflict between things optimal for the patient before us at the moment and for other patients (those whom we are about to treat, whom other clinicians treat, patients untreated, and future patients) is not only the stuff of ethics, phil- osophy, and politics, but must also be addressed at the bedside and by local policy committees.
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