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One of the major challenges facing today's clinicians is the rising cost of healthcare. Sports and exercise medicine clinicians can address these challenges by making a working diagnosis on clinical grounds and using investigations only selectively. They should also educate their patient about the limits to funding and be prepared to use time as a diagnostic aid.
As clinicians we face many challenges. Hippocrates challenged us to ‘primum non nocere’—first do no harm. Second, the challenge is to practise medicine in a scientific manner. This has evolved from anecdote and case studies to evidence-based medicine, where such evidence exists. The third and potentially most difficult challenge is to practise affordable medicine.
In the 1950s, when I was born, the limits to medicine were largely around what we could do. Now the limits are increasingly around what we can afford. This is a major challenge facing health systems in many countries and is fuelled by several factors: demand for health services will always exceed society's ability to pay. This is compounded by physicians feeling duty-bound to advocate for their own patients. Additionally, politicians realise that health is an emotionally sensitive issue and funding decisions are often made in response to pressure from special interest groups—this has been termed ‘planning by decibels’. The Herceptin (Roche Basle, Switzerland) debate in New Zealand is a good example of this.1 Herceptin is a high cost drug used in the treatment of breast cancer. Funding for this drug was granted to New Zealand women after a high-profile campaign by women's health advocates.
Health administration is a science which is in its relative youth. Secondary and tertiary care services chew up the majority of the health budget. These are hospital based and several decades ago hospitals were usually run by a triumvirate of a medical superintendent …
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