Dartmouth Atlas Challenges Ethics of 'Doctor-Centric' Care
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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