Wishful thinking that something like this would work. As long as someone else is footing the bill, many won’t care about the macro-effects of their medical decisions:
Proscriptions (sic) could be aided by legislation demanding Doctors inform Patients in percentage terms the likely benefit of such Drug use; most truly sick Patients can understand a Doctor who says this Drug will make you feel 10% better at $12/day. They could also understand a Doctor who states this Testing procedure at $800/per Test will give the Doctor a 7% greater surety of what is actually bothering the Patient. Other Patients might achieve greater comprehension hearing a Doctor state: Chemotherapy and Radiation treatments at $40,000 per year might keep you alive the two Years which I think you will live, but you will feel worse than you ever have before in your life; this combined with a 90% chance you will die in two years, and a 40% chance you will not last out the year anyway.
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{ 5 comments }
99.99 percent of my patients would never want anything like this. Most just say “what do you think I should do” or ask that if they were my mother, what would I recommend then (same thing, I hope). An outright quantitative odds-weighted analysis is the last thing they want to hear, although some might expect I would make that analysis myself before making my recommendation.
Most people just want to hear what I think is best and maybe a couple of reasons why. If they trust me at all, they trust me to be straight with them.
It ain’t all economics. Some of this comes down to the ‘informed’ part of informed consent. Cancer patients might wish to maximize their utility, what they can do and how they feel while doing it times the time available. It might sometimes be the case that patients feel like shit for so long that the added few months of life are insufficient to make up for lost time feeling shitty. Plus, there is the chance with any therapy that it might kill you tomorrow and all time is lost.
Even if the economic discussion does not influence patients, the full picture of the balance of effects from a therapy is important to their decision making.
I think a lot more that .01 percent of people would like to know the odds that a treatment or a test would benefit them. I am not sure about very sick patients – as gasman says it might really depend on an individual situation.
I think healthy people would certainly like to know the probability of whatever a test is supposed to rule out vs the risks of the test itself. People with high deductibles would also be very interested in cost of the test.
All this is a waste of time. All that is needed is a Medicare formulary, one negotiated by CMS, then followed by Medicare and private payors. This would be simple for doctors and patients alike. If you want or need something different, you or your private plan pay the difference in cost. I would also suggest capping the number of covered medciations at 5 without special approval or being out of pocket. Doctors would not enjoy the headache paperwork, and would be less inclined overprescribe. Patients would decide how much they really prefer Plavix ot ASA. This really is easier than it seems. We have operated under a cap of 3 covered drugs with Texas Medicaid in the past.
I know that detailed odds information sounds appealing to the sorts of people who read med blogs, but the very scary truth is that patients DON’T know what to do with that sort of information and even if you give it to them, they just ask you what you think ….
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