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Dartmouth Atlas Challenges Ethics of 'Doctor-Centric' Care

Cheryl Clark, for HealthLeaders Media, March 3, 2011

Here's an example of how doctors aren't correctly informing patients, Barry continues. When a large cohort of Medicare patients who had undergone elective stent procedures for chest pain or stable angina were asked why they had the procedure, "three-fourths said, 'I did it to prevent a heart attack or to live longer.' But we have randomized trials with tens of thousands of patients that say that's not what stenting is about. It can reduce angina, although patients treated medically can catch up over a couple of years," Barry says.

Meanwhile, stenting in and of itself carries risks of generating clots or strokes, heart attacks, and even death.

Barry points out that in studies that made sure patients had all information about procedures available for their conditions, they were 20% more likely to make more conservative decisions than their doctors recommended.

The report explained in detail courses of care for eight procedures for which non-surgical options are just as reasonable to recommend.

For example, "there is little evidence that surgery is better than non-surgical treatment for chronic or persistent non-specific low back pain in patients who do not also have leg pain." Often the pain goes away on its own, yet surgery is risky and often patients are no better – and sometimes worse off – than before.

Nevertheless, rates of back surgery vary six-fold, depending on what part of the country a patient happens to reside. For example in Casper WY, surgeons perform 10 surgeries per 1,000 Medicare patients while in Honolulu, the percent is 1.7 and across the U.S., the rate is 4.3.

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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.