Give patients the pros and cons of treatment options

If you or someone you love is considering surgery or an intensive treatment, it really pays to be sure you understand the pros and cons.

While that seems like common sense, millions of people say “yes” without learning all the facts.

Some simply rely on the trust they have in their physician. Others assume the known benefits and risks are too complicated to fully understand. And some people just want to get their problem fixed.

It turns out that when people hear the pros and cons of a procedure or surgery they’re considering, many opt out.

I’ll tell you an example from my own experience that I’ve never forgotten. When I was in nursing school at UCLA, I had a patient who was going to get extensive surgery the next day. He had a lot of questions.

I reviewed his chart and the consent form he was going to be signing, and realized he didn’t know much about what he would be experiencing. I was surprised to find out that he was unaware that his tongue was going to be removed as part of the surgery. He didn’t like that. So I encouraged him to talk with his physician before he proceeded.

He did. And then he promptly checked out of the hospital.

The next day I was summoned to the nursing school’s Dean’s office because the surgeon had complained about me. I went there imagining all the other careers I might be interested in pursuing should I be kicked out of nursing.

Instead, the Dean commended me for representing the patient’s interest. And I learned something very important: never assume you know — or as in this case, your patient knows — what’s needed in order to make the right decision.

What your physician thinks is the smart thing to do may not end up being what you personally are comfortable with. And that’s OK.

That’s why I liked this study in Health Affairs this month about the impact of giving people a good overview of the pros and cons of treatment options. Group Health Cooperative, a nonprofit health system in Seattle, Washington offered evidence-based video information about making decisions about surgery to people with knee and hip osteoarthritis.

With more than 27 million Americans dealing with osteroarthritis, joint replacement surgeries are increasingly common. Surgery is not the only option for many people; there are a range of nonsurgical approaches that can help relieve the symptoms.

The video offered patients unbiased information about the three-month recovery time for joint replacement, the 10 to 20 year lifespan of artificial joints and potential risk of infection or repeat surgeries.

Group Health found that after informing people thoroughly about the pros and cons — and other options — they saw a 38 percent reduction in knee replacement surgeries, a 26 percent decline in hip replacement surgeries and a 12 percent cut in health care costs over six months.

“We have long made the case that making sure patients are informed by giving them high-quality decision aids is the ethical way to practice medicine, said Floyd “Jack” Fowler, senior scientific advisor at the Informed Medical Decisions Foundation. “This study is the best demonstration that providing decision aids is both a way to improve the quality of medical care and a way to potentially reduce the costs of care,” he added.

The more you know about your situation and your options, the better your decisions will be.

Barbara Bronson Gray is a nurse who blogs at BodBoss.

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  • Sharon

    Thanks for driving this point home. It reminds me of a story heard by a
    colleague years ago: A surgeon was discussing the option of surgery
    with a cancer patient that would involve removing the man’s testicles.
    The man was readily agreeable, adding plenty of : “Whatever you think is
    best, doc.” The physician was concerned that the man might not be
    understanding clearly because of the lack of emotion displayed. He
    finally, point blank, told him: “Look, I’m going to cut your balls off
    ____.” The man incredulously looked at the physician and exclaimed: “The
    hell you are!”

    It gets so much stickier with psychotropics
    because of the lack of insight into illness that some may have. Those of
    us in the field have all had the experience of someone whose poor
    insight already precludes them from seeing the importance of any
    medication tx, even though they face hospitalization [or jail!] without
    it. So it’s tempting to not mention some of the rarer, more serious side
    effects one can experience with medication [or other more minor ones
    that WE decide are minor compared to a decompensating mental state].
    However, if info is withheld, not only is that unethical, it can destroy
    the trust between clinician and patient. What to do??? Sure can be
    challenging.

  • http://twitter.com/ValerieAJackson Valerie A. Jackson

    Nice read!

  • drjoekosterich

    Treatments and tests can have benefits but these are often overstated and the very real risks downplayed. People need to know the facts on pros and cons so they can make a genuinely informed decision.

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