Not long ago, I was talking with a news reporter about an article we published on how surgical decisions are made. The paper reported that surgery patients too often were not given enough information about reasonable options. During our discussion the reporter remarked that the findings of the study were all well and good for some people, but didn’t apply to her elderly dad. Her dad would never have wanted to have information or be involved in medical decisions about his care. Instead, he would just look to his wife to tell him what to do.
The debate over the U.S. Preventive Services Task Force's (USPSTF) final recommendation on PSA testing continued this week. Michael Barry, president of the Informed Medical Decisions Foundation and Mary McNaughton-Collins, medical director, each had an opportunity to speak on NPR radio programs about the USPSTF recommendation this week. They voiced their views on the recommendation -- both from the perspective of the Foundation and as practicing primary care physicians.
Each "Voices" blog segment will feature a person we believe has a unique and valuable perspective on shared decision making. Today's guest is Peter Ubel, MD, author of "Critical Decisions." 1) In your own words, what is shared decision making and how does it improve the quality of health care? Put simply, shared decision making is the gold standard -- the sine qua non* -- for how medical decisions ought to be made. The pipe medical choice is rarely a function of medical facts alone. Tough decisions require value judgments, and it is the patient’s values that often determine which choice is best. An operation cannot be a “success” unless it was the right course of action to take for an individual patient. Treatment cannot “work” unless it was the treatment that best fits that patient’s individual preferences. Quality of care begins with shared decision making.
The Dartmouth Atlas Project has released the first four of nine regional reports looking at the variation in elective surgery rates for 306 hospital referral regions across the U.S. The report shows that whether Medicare patients undergo elective surgery depends largely on where they live and the providers they see. Authors found that for many conditions, especially those where elective surgery is an option, the treatment a patient receives depends more on the physician’s recommendations than the patient’s preferences.