Katherine Hobson, writing for the Wall Street Journal, provides an interesting article on back surgery and shared decision making.
Say you’ve got lower-back pain. Your doctor concludes it’s not due to anything particularly serious, but it hurts. Medical research provides no clear answer on the best thing to do: some people opt for the passage of time, NSAIDs, physical therapy or other non-surgical approaches, while others end up getting operations. With any of those paths, some people get better, some get worse and some stay about the same.
Given that uncertainty, what determines whether you get surgery or not?
According to a new report from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making, it’s where you live and which doctor you see. The rates of back surgery among Medicare beneficiaries, for example, ranged from 1.7 surgeries per 1,000 in the Honolulu area to 10 per 1,000 beneficiaries in Casper, Wyoming. Researcher also found this kind of regional variation in elective surgery rates for early-stage breast cancer, knee and hip arthritis, gallstones and other conditions.
The issue isn’t that people shouldn’t be getting back surgery or taking NSAIDs, but that there are “many decisions that both physicians and patients are involved in every day where there are many different options to care for a patient, and a fair amount of uncertainty about the ideal treatment choice,” said David Goodman, co-author of the report and co-principal investigator for the Dartmouth Atlas Project, on a conference call with reporters.
And, the report says, those decisions shouldn’t be made by the physician alone, but through a process of shared decision making, in which a patient learns about the pros and cons of each option and makes a choice in conjunction with his or her physician. (The WSJ’s Informed Patient columnist, Laura Landro, has written about shared decision making.)
“When patients don’t have this chance to make a fully informed choice, physicians are at risk of prescribing the wrong treatment for the wrong patient — something they wouldn’t have wanted had they understood what was at stake and had the opportunity to share the decision with the doctor,” said Shannon Brownlee, lead author of the report, on the conference call.
Richard Deyo, MD, et al provides research on involving patients in clinical decision making related to back pain. Full research paper here >>>
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