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Give Decisions to Patients, Not to Experts- New Book


Posted on Apr 16, 2012

Patients know what medical care is best for themselves, say the co-authors (from Harvard Med and Boston's Beth Israel Center) of a new book on medical decisions.

They note that the old paternalistic attitude in medicine, in which the doctor prescribed a treatment and the patient listened, was fading, but the proposed replacement from Washington is no better. This proposal centerpieces experts, who pour over pages of data and produce "best practices."

On the one hand, Democrats prefer government panels of experts like the US Preventive Services Task Force (PSTF), which in 2009 recommended against routine mammograms for women under 50 and last fall recommended against prostate screenings in healthy men.

On the other hand, Republicans prefer experts at insurance companies, like United Healthcare, whose "Health in Numbers" initiative promises the moon and more for patients.

But the authors say these experts miss the point. When patients study enough of the research, they realize very little consensus is ever achieved. Patients therefore generally do not listen to what "experts" say and instead adapt personalized behavior patterns as patients, sometimes opting for more treatment, and sometimes not. Personalities and past experiences determine these preferences, as is also the case among experts. The PSTF, for example, is a "minimalist" panel, because they opt for less treatment. The American Cancer Society, which disagrees with the PSTF on both mammograms and prostate checks, has a different personality.

To the authors, no one can really tell how a patient is going to react to any treatment and as long as the data remains ambiguous, "the 'right' clinical decisions turn out to be those that are based on a patient's goals and values."

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