Environment Right for Shared Decision Making

Frank Diamond

Managing Editor

When I underwent hernia surgery years ago I pretended in the days leading up to the knife to shrug off the prospect. It was and is a minor outpatient procedure. A friend asked if I’d gotten any advice other than that given by my primary care physician and the attending surgeon. No, I said. She pointed out that “Surgeons like to cut. That’s what they do.”

Our cover story on shared decision making (SDM) reminded me of that instance. Author Joseph Burns reports how patients with benign prostatic hypertrophy were often left in the dark about some of the unwanted outcomes of the procedure, such as incontinence or impotence.

Now, “In a variety of clinical settings, electronic medical record systems alert physicians about the need to offer patients decision aids. Those aids may be videos seen on the Internet or distributed on DVD by mail.”

The technology is there, but so is the mindset. Federal regulations for accountable care organizations (ACOs) and meaningful use standards for electronic health records promote SDM as a way of more fully engaging patients. And indications are that they’ll need to be more fully engaged. A recent study finds that while baby boomers might live longer than their parents, they’re also sicker by a long shot.

Baby boomers — who, in the study, were people 46 to 64 between 2007 and 2010 — have higher cholesterol and blood pressure and suffer more from diabetes than did their parents.

While 32 percent of the older generation described their health as excellent, only 13 percent of baby boomers did, according to the study in the February issue of JAMA Internal Medicine. Baby boomers are also more likely to be obese and suffer from cancer and hypertension.

I saw no mention of hernias, but if the occasion should again arise I will probably talk to more than just my surgeon.

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