Shannon Brownlee (author of the excellent Overtreated) writes that spending the time with patients to undergo shared decision making can help reduce unneeded medical therapy:
It turns out that when patients have access to decision aids, and they share the decision with their doctor (usually their primary care doctor), they are less inclined to undergo invasive procedures than patients who learn about treatments in the usual way ““ often during a hurried conversation with an overworked physician. Sometimes patients are a lot more reluctant to undergo tests and procedures once they really understand the tradeoffs. For some surgeries, patients who have access to shared decision making are 60 percent less likely to choose the surgical option.
Sounds good in theory, but can it be applied to the real life? It’s doubtful.
First off, are decision aids readily available for the thousands of available diagnostic and therapeutic procedures? If so, please tell me where they are. Having them easily assessable to physicians would be a good place to start.
Next, shared decision making takes time, which the current payment system does not pay for. Without financial incentives, it doesn’t get done. Harsh, but true.
Finally, does the legal community accept shared decisions should the medical outcome go awry? Dan Merenstein did everything Brownlee suggested, and we all know how he was rewarded for his efforts.
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{ 4 comments }
Shared decision making is great in theory, but like you said, in practice it is difficult to do.
My guess is you would have to have exhaustive and very time consuming discussion and documentation, almost like a legal contract with the patient, for it to protect the doctor when the patient’s “shared decision” results in a bad outcome.
If I were a lawyer, the first thing I would advance is the idea that the patient really didn’t understand the decision at hand, and if he did, he would have chosen differently. So unless you spend a huge amount of time and effort documenting that every possible negative outcome was discussed, you’re not protected.
Everyone in the nation has internet access. That access has created the duty to Google. No claim for lack of informed consent has any merit anymore. The patient has access to professional quality data. He has the time and incentive to join chat rooms to learn of the experience of other patients, including disgruntled ones.
The duty to Google has also invalidated all claims of loss of chance. This is a bogus claim invented by rent seeking law profs in the 1970’s. Rent seeking lawyer running dogs on the bench picked it up to promote lawyer jobs and enrichment. It means that a delay in diagnosis and treatment of a hidden disorder reduced the chance of a positive outcome by some fraction. The patient now has a duty to research all persistent symptoms, and to change doctors.
The reason the duty to Google is that of the patient is that the patient has second to second facts of his own condition. He is the world’s expert on the disease in his own body. He just needs to understand it better with universally available technical information.
Maggie Mahar comments on that post here.
As a passenger, I want to arrive, not pilot training. As someone with a broken toilet, I want it running, not a plumbing apprenticeship. As a patient, I want relief. I do not want a medical education.
This is more left wing complication for the sake of lawyer gotcha and rent seeking. This doctrine is left wing pretext to generate more cost and to bully the medical profession.
Any medical collaborator with this garbage should be shunned. Any doctor sued for failing to provide it should file a cross claim against any party endorsing it and seek a federal injunction against the state.
Any patient or bullying family demanding this garbage should be expelled from the office.
There should be zero tolerance for further interference with the patient-doctor relationship.
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