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Dartmouth Atlas Challenges Ethics of 'Doctor-Centric' Care

Cheryl Clark, for HealthLeaders Media, March 3, 2011

The researchers emphasize they are not suggesting that physicians are just trying to generate income and volume, although that may, in some cases, underpin the rationale behind a more aggressive course of care.

Rather, they say, it's about making sure the patient is fully informed of all the pros and cons of every treatment option – surgical and non-surgical—and they are fully informed about the benefits and risks, recovery periods, perforations, risk of stroke and even death from having an invasive procedure versus taking drugs and changing their lifestyle.

For instance, a patient might not realize that surgery for back pain would require a two-month convalescence with limited mobility, whereas with a non-surgical option such as physical therapy, medication and exercise they may have a similar outcome.

One of the authors, Michael Barry, MD, explains the issue as one that is at the epicenter of patient safety and quality and reducing medical errors.

"The patient safety movement in the last decade has worked very hard to make sure that the wrong patient doesn't get surgery, that Mr. Jones doesn't get taken down to operating room for surgery that was scheduled for Mr. Smith, and that's really important," Barry says.

"But if Mr. Smith were fully informed, and would then decide he would neither need nor want this surgery, then taking him to the operating room is like operating on the wrong patient as well."

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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.