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



The notion of an informed shared medical decision made by patients advised by primary care physicians and others could hurt fee-for-service specialists' and hospitals' revenue by reducing volume. But it could greatly improve quality of care and the health of the healthcare dollar.



9 comments on "'Informed Decision' May Irk Surgeons as It Cuts Costs, Improves Quality"
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.
Carolyn Thomas (8/18/2012 at 8:58 AM)

Surgeons like to cut. What else can we say?
DonS (8/17/2012 at 9:04 PM)

Wow Jerry! You must have had a bad experience with a primary care doctor who evidently doesnt know the names of bones! I would say you are sufficiently irked by the article as suggested, but you have to admit there could be some improvement. Your anecdotal evidence is disturbing, but just like my anecdotal evidence of the cardiologist who told me "It doesnt matter what your stress echo says, I'm going to stent you no matter what." (She didnt work for HCA!)
Karen (8/17/2012 at 9:43 AM)

I agree. I am so glad to see something like this implemented. I have had a couple of surgeries and the problem still exist if not worse.
Jerry antebel (8/16/2012 at 11:18 PM)

What a crock -!!!! Specialists know the bones in the body[INVALID][INVALID]most fam docs, nurses, have no idea about anatomy, knee ligaments, names of bones in hand, etc.... Cannot wait until you primary care "gods" you think you are, start taking care of all the "no-pays, medicaids, etc that specialists take care of Next up[INVALID][INVALID] The germ theory has been invalidated by "Dartmouth". You primary care GODS who think you know more about a patient with Ortho problem...... Wait till you are hobbling in severe pain[INVALID]-you will want your knee replaced Primary docs who order wrong tests, hold patients from care, etc is the problem , not specialists[INVALID][INVALID]you will see[INVALID]-rationing is horrible , and I hope each of you who think you can out diagnose, out treat a " procedure-happy , greedy specialist " as you paint us[INVALID][INVALID] have 100 lawsuits a year. And don't dare call me with some bullshit question 10 times a day because you don't even know names of bones in body..... You are a disservice to our country and patients with this rationing gimmick.... SHAME ON YOU I have suffered with rotator cuff tear for 4 years... To prove a point Yea, I can still function every day, but it hurts every day.... Point is I and my surgeon should decide, not an insurance company and certainly not an INFERIORLY trained primary care doctor.... All you guys will be replaced with rnp and PAs soon, so I guess you are trying to get a gimmick going!!!!!!!!!
Bobbie Jenke (8/16/2012 at 7:40 PM)

YES! Cheryl, I agree. Patients should know all the data, long term outcomes and more before undergoing any surgery or procedure. I learned by painful experience. But, what I also learned from much deeper looking is that no one is monitoring the research studies, and many are flawed, even in top medical journals and in the hospital records of surgery results. Surgeons and their hospitals doing procedures have been able to lie or leave out the true outcomes of procedures, so how can a patient or other doctors really trust the statistics? I worry that the problem is still too deeply entrenched in a well-protected Medical Industry that is motivated by profits. Making money is the bottom-line. Real patients and their families who have had these procedures MUST factor into the equation[INVALID]by posting websites of both their short-term and long-term outcomes-blogging after surgeries day by day, videos, and more. And there must be a way to verify that they are really patient of the procedure. If you choose to print any comment of mine, do you mind printing this one, instead of my other one. I live in pain, and I think this is stated better. As a patient injured by the medical profession[INVALID]who has met many other patients in my same situation[INVALID]I really think the post-surgical patient views must factor into this for any new patients to be fully informed about the surgery they might consider. Thank you for your thoughtful article. Bobbie
Bobbie Jenke (8/16/2012 at 6:27 PM)

Hi Cheryl: Good article, but I have concerns about REAL informed consent for patients. I did my research on T.O.S. surgery, or I thought I did[INVALID]but later learned that the Research was flawed. Top surgeons in top Medical journals had been lying or hiding the bad results of their surgeries-which are many. This must be addressed. Asa Wilbourne, neurologist, at Cleveland Clinic began to assess this I believe, but sadly now deceased. In a Fee for Service society[INVALID]hospitals are STILL going to want to get richer[INVALID]as are malpractice companies, surgeons, etc. I think more patients need to tell of their outcomes on websites and You Tube with names of surgeons and hospitals over and over[INVALID]in order to get REAL DATA over long term. Thanks!