Shared decision making

Great in concept, with this article talking about the PSA in particular:

The prostate-specific antigen, or PSA, test is a simple blood test that can detect prostate tumors on average 11 years before a rectal exam does. To anyone who assumes that catching prostate cancer as early as possible leads to cures, the PSA test looks like a no-brainer.

But the evidence doesn’t support that view. If early diagnosis of prostate cancer were really effective, then the mortality rate for the disease should go down as more and more men are screened. There has been a slight drop in the mortality rate in the United States in recent years, but screening may not deserve the credit. Mortality also has declined in Britain, where men are rarely given the PSA test.

I completely support the approach of shared-decision making between the patient and physician. However, I am skeptical that it will take off in our current malpractice climate. Go ask Daniel Merenstein.

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