The Imperative of Teaching Cost Consciousness in Graduate Medical Education

Residents are taught, or should be taught, the fallacy of believing that “if all you have is a hammer, everything looks like a nail.”1 Using the wrong technique, the wrong drug, or the wrong therapy can do more harm than good. An important lesson is that sometimes doing little or nothing is appropriate care. The rapid rise in health care costs in the United States—from an inflation-adjusted $2,855 per person in 1990 to $9,255 in 2013—reflects, in part, that physicians are working with more than a hammer in caring for patients.2 But it may also indicate an indiscriminate use of the resources available. Other advanced industrial countries, with access to the same tools but often constrained by costs, spend far less than the United States, a country that also underperforms its peers on most measures of quality and access.3