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

Cheryl Clark, for HealthLeaders Media , August 16, 2012

The surgeon isn't part of the process.

Instead, patients would learn from experts—perhaps hired by the health system or the payers—whether they meet indications for the procedure or whether there are feasible alternatives.

They'd see data on complication and infection rates, track records and experience levels for the hospital and/or the surgeon, adverse events of required medications, post-procedure functional limitations, challenges to recovery, and rates of repeat surgery.

They would learn about the likelihood of the procedure actually accomplishing what is expected, even if all goes perfectly. And patients who have undergone the procedure would explain what happened to them.

Unnecessary surgeries

Some healthcare systems will bridle at this idea. Specialists insist they never operate on a patient who is unlikely to benefit.  And family doctors may not want to be bothered with more bureaucratic steps in a referral process they have to do more to vet.

But consider just a few recent headlines to see the paving of the large runway that may enable this plane to take off.

• A New York Times story last week revealed some 1,200 patients underwent unnecessary invasive cardiology procedures in one South Central Florida hospital, and many other facilities in the large HCA chain are under federal investigation.

• A Grand Rapids surgeon's study in September's Journal of Clinical Oncologysays far too many patients undergo unnecessary surgery to remove tumors in patients with advanced colon cancer when chemotherapy and a drug have a better success rate.

• A report in the New England Journal of Medicine found many women with breast cancer are unnecessarily undergoing a second surgery to remove more tissue for wider margins.

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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.




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