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Dartmouth Atlas Challenges Ethics of 'Doctor-Centric' Care

Cheryl Clark, for HealthLeaders Media, March 3, 2011

For example, the study questions why:

• Beneficiaries in Sioux City, IA with osteoarthritis are more than five times as likely to undergo hip replacement surgery as those in Honolulu.

• Male beneficiaries 65 and older with benign prostatic hyperplasia undergo transurethral resection (TURP) in Idaho Falls at a rate five times greater than the rate for men in Terre Haute, IN.

• Women in Victoria, TX are seven times more likely to undergo radical mastectomy for early-stage breast cancer, as opposed to a lumpectomy, than women in Muncie, IN.

The bottom line, says Shannon Brownlee, the report's lead author and instructor at the Dartmouth Institute for Health Policy and Clinical Practice, is that "different doctors have different opinions about the best way to treat a given condition."

In short, the patients are not getting the full story about what's in their best interest, what suits their goals and lifestyle preferences.

"Often times, the physician's preferences and values tend to supersede the patient's," says David Goodman, MD, the report's co-author and co-principal investigator for the Dartmouth Atlas Project.

"What we found is that physicians differ very strongly in their opinions about the value of these procedures, and that there are regional differences, that one might think of almost as differences in culture of care that develop, partly related to how they are trained or the history of the practice. But often these physicians are quite unaware that they practice differently from a quite similar community halfway across the country," Goodman says.

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4 comments on "Dartmouth Atlas Challenges Ethics of 'Doctor-Centric' Care"


Susan (3/8/2011 at 2:09 PM)
This report needs to take into consideration cultural aspects of the information. Yes there are more back surgies in Montanna- what do people do for a living in Montanna? Ranchers- heavy lifting. Why would any Doctor recommend surgery over physical therapy if it wasn't necessary? Chances are there are more serious back injuries in Montanna than Souix Falls

Steve Wilkins (3/4/2011 at 6:33 PM)
The report's conclusion that the results reflect a highly "doctor-centered" practice style is consistent with a preponderance of evidence which shows that a "patient-centered" (communications style)is still the exception rather than the rule, at least for primary care. Check out a blog post which addresses this very subject: http://wp.me/pGXmn-1O

Ronald Hirsch, MD (3/4/2011 at 4:23 PM)
Doing things to patients pays, talking to patients does not. Fix the payment system and you'll fix this problem.