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'Informed Decision' May Irk Surgeons as It Cuts Costs, Improves Quality

Cheryl Clark, for HealthLeaders Media, August 16, 2012

A $26 million incentive

The Center for Medicare & Medicaid Innovation in June gave Dartmouth $26 million to implement shared-decision models throughout 15 million healthcare systems covering 50 million patients in 17 states.

In Boston, the Informed Medical Decisions Foundation is developing tools for health plans and others to help patients learn more about the procedures they are about to undergo.  The foundation defines an informed decision even more broadly.

"We're now suggesting that medical necessity is not only an appropriate procedure, but one the fully informed patient wants," says Richard Wexler, MD, the foundation's director of patient support strategies. "Even though the operation may be clinically appropriate, some people may not want to take the risk once they know what that is. They may give up the tennis game rather than incur the pain and the risk of complications."

And even some professional societies are guardedly getting on board with the idea, even if in a preliminary way.

"Surgeons don't always present things in an unbiased fashion," acknowledges Lisa Cannada, MD, spokesperson for the American Academy of Orthopaedic Surgeons who works at Saint Louis University in Missouri.

"A surgeon with a specialty in a certain procedure believes a patient will benefit, and instead of trying physical therapy and injections, they'll just go right ahead and do the procedure," when conservative approaches might be better.

David Hoyt, MD, a former trauma surgeon who is executive director of the American College of Surgeons, says his organization is working on a "risk calculator" to help surgeons "have an informed-consent discussion" with their patients based on their co-morbid conditions.

"We support patient education that gets to their expectations about what an operation involves," he says.

And there is the Choosing Wisely campaign, a collaboration of nine specialty societies to help patients and their doctors ask the right questions about the type of care they really need.

Of course there are downsides.  New information may confuse or scare patients away from getting what they need. But smart thinkers can design these models to minimize that chance.

Bottom line: If patients have a better appreciation of what's about to happen to them, and really are a bigger part of this decision, how can that be a bad thing for healthcare?


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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9 comments on "'Informed Decision' May Irk Surgeons as It Cuts Costs"


Marshall Steele MD (8/20/2012 at 9:32 AM)
One of the biggest issues we have in medicine is that in my experience only 2% of surgeons collect and aggregate their patient rpeorted outcomes pre and post operatively. They can't accurately provide informed consent based on their own experiences? Our data base shows there is considerable variation amongst providers doing the same procedures. Quoting the literature is not the same as quoting your results. Until collecting and providing your own data to patients becomes part of the medical culture "second opinions" and "informed consent" will be less than accurate. Technology has made this much easier and affordable to accomplish.

M Makary (8/18/2012 at 7:32 PM)
Excellent article

Phillip (8/18/2012 at 12:00 PM)
The concept may be good but the process proposed is inherently flawed. In general, the Physician ordering a test (other than an x ray) should be a physician who is trained to interpret the test and trained to provide appropriate treatment options, either non-surgical or surgical. That physician is usually a specialist This "Informed Decision" process will not "irk" surgeons providing it does not add unnecessary bureaucracy which increases cost, and does not delay necessary treatment which is urgently needed in some cases. Informed patients are a surgeons ally not adversary.