Parsimonious care: a practice encouraged by guidelines from the American College of Physicians, lauded by some as a high-profile acknowledgment of the need to control skyrocketing medical costs but criticized by others as an opportunity for physicians to withhold care.

In January, when the ACP published its new ethics manual for its 132,000 members (it is the second-largest physician group after the American Medical Association), interest was piqued by one passage: “Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient respects the need to use resources wisely and to help ensure that resources are equitably available.”

In an accompanying editorial, physician and bioethicist Ezekiel Emanuel of the University of Pennsylvania deemed the guideline “truly remarkable”: “These positions on efficiency, parsimony and cost-effectiveness constitute an important shift, if not in ethics then in emphasis.”

Yet some physicians and bioethicists are uncomfortable with the shift, not least because of the ACP’s word choice. Though the first dictionary definition of parsimonious may be “careful with money or resources,” it’s followed by a decidedly negative connotation: “especially: frugal to the point of stinginess.” Critics express concern that some physicians, under pressure to control costs, will withhold a test or treatment despite clear benefit, and foresee that the debate will help fuel already heated discussions about health care spending.