Saturday, March 5, 2011

Sharing Decisions with the Doctor

When faced with a medical crisis, patients often look to doctors to make care decisions for them. When your body rebels or broad-sides you, it's a relief to have someone with the pertinent knowledge to tell you what to do. But while the days of a woman going into the hospital for a lumpectomy and coming out of anesthesia with a full mastectomy are over, thanks in part to the patient autonomy movement of the 70s and 80s, doctors still play the largest role in determining a patient's treatment path. As the doctor-patient relationship becomes more institutionalized doctors no longer have the intimate relations with their patients that they once did - if they ever did! - that allow them to account for a patient's lifestyle and care choices. From a new op-ed at The Lancet:

The Dartmouth Atlas Project found that whether patients underwent elective surgery largely depended on where they lived and the clinicians which they saw. For example, patients with heart disease in Elyria, Ohio, were ten times more likely to have a procedure such as angioplasty or stents than were those in Honolulu. And women older than 65 years living in Victoria, Texas, were seven times more likely to undergo mastectomy for early-stage breast cancer than were women in Muncie, Indiana. Such wide variations underscore the need for improving shared decision making, say the authors.
The importance of shared decision making is clear, especially when considering a disease such as early-stage breast cancer, in which mastectomy or lumpectomy and radiotherapy have similar survival outcomes but are very different treatments for a patient to undergo. It is crucial that doctors inform patients of the pros and cons of each and invite them to participate in the management choice.
The op-ed also notes that the "Dartmouth-Hitchcock Medical Center in New Hampshire already has the nation's first dedicated Center for Shared Decision Making." Considering the paternal history of medicine, "already" seems decidedly inaccurate.

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