Dartmouth Atlas Challenges Ethics of 'Doctor-Centric' Care

The latest report from the Dartmouth Atlas Project, doesn't reinforce confidence in the equanimity of the nation's healthcare system. Again.

Rather, it reveals some troubling ethical quality and safety issues about what Dartmouth investigators are calling a "doctor-centric" medical delivery system for Medicare beneficiaries practiced in much of the country.

In eight medical conditions in which there is an aggressive elective surgery option versus other equally effective courses of care, doctors are making decisions without consideration of the patient's point of view, the Dartmouth project's authors say. In some cases, the patients probably never fully understood that other equally reasonable and effective options that didn't involve surgery were available to them.

"What often happens, [is that] providers assume that they can diagnose patient preferences, and that they can know what's important to patients," says Richard Wexler, MD, a director at the Foundation for Informed Medical Decision Making, which collaborated with the Dartmouth Atlas on this report.

"But what we're finding is that in this new day in healthcare, where much of the 'family doctor type of image' has passed, providers are really not very good at diagnosing patient preferences and they often will get it wrong. That's a strong argument for trying to engage patients in part of the decision making process."

The report issued last week, "Improving Patient Decision-Making in Health Care," revealed this phenomenon by demonstrating the wide and unexplained variation across the country in the use of more aggressive types of care in these eight surgical procedures plus prostate cancer screening.

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