Medicare Patients Given Fewer Treatment Options

More than one-third of Medicare patients who underwent a prostatectomy, and 90% who had elective insertion of a coronary stent, said their physicians gave them no advance information about more conservative options that produce similar survival outcomes, says a survey conducted by the Dartmouth Institute and the Informed Medical Decisions Foundation.

The results indicate that rather than guide patients to thoughtfully consider alternatives, physicians are still paternalistically making those decisions for their patients—without discussion—on grounds that they think they know what's best for their patients, says principal investigator Floyd J. Fowler.

"There's a big tradition of physicians taking responsibility, and being paternalistic when these decisions are made," Fowler says. "I won't argue that they weren't trying to be beneficent when they made these decisions, but we think this is not the way decisions like this should be made," especially when the invasive procedures in question carry considerable risks and side-effects.

The paper by Fowler and colleagues is published in the March 2 issue of the Journal of General Internal Medicine.