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

Cheryl Clark, for HealthLeaders Media , August 16, 2012

Get ready for the latest idea in healthcare, the informed shared medical decision.  It's a concept that will either make you angry enough to scream or restore your faith in the system.

I hope it does the latter.

Because if this idea takes off, as it probably will, it's certain to dramatically narrow the field of patients who unnecessarily go under the knife or scope, even if it upsets some surgeons and interventionalists in the process. 

Yes, it could hurt fee-for-service specialists' and hospitals' pocketbooks by reducing volume. But it could greatly improve quality of care and the health of the healthcare dollar.

The process might work like this: Instead of the primary care physician referring a patient to a specialist for a non-emergent procedure—say, an operation on a bum knee—as is done today, the PCP would order and review the imaging tests, and then refer the patient to a class, a DVD, or an interactive online tool.

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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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