By David Kendall and Jackie Stewart Usually the start of basketball season is full of optimism. But one superstar has regrets — not about a tough loss in the finals two seasons ago but, rather, about his medical care. And he is not alone.
The face of the Miami Heat franchise, Dwyane Wade, says surgery to remove the meniscus from his knee 11 years ago led to the ongoing knee problems he’s had. He thinks that if a longer-term approach was used, he may not have as many issues today. Sure it got him back on the court faster, but at the cost of multiple painful and expensive follow-up procedures and treatments.
Wade’s story is actually not confined to sports giants — it’s a common and frequent patient experience. When people are confused and anxious after receiving a diagnosis, it’s hard to choose between treatment options, especially if your doctor doesn’t know what your preferences or goals are for your recuperation. This confusion leads to a lot of wasteful care, unsatisfied patients, and unnecessary spending.
Luckily, there are a series of health care innovations across the United States that have found better ways for people and their doctors to make good health care decisions. These simple, informative, and objective “discussion guides” (also known as patient decision aids) allow patients and doctors to have a productive conversation about medical options. By making more informed decisions, patients have better experiences with their treatment. Better treatment also leads to less waste — from extra tests to follow up procedures that could have been avoided — saving Medicare $11.4 billion over the next decade.
Doctors at the Dartmouth Hitchcock Medical Center in New Hampshire have been seeing the benefits of discussion guides for years. As a standard practice, they give women with breast cancer a “pre-visit” medical discussion guide to review before they meet with a surgeon about treatment options. The guide includes a DVD that shows various ways that women with breast cancer have faced the disease and how they determined the best treatment option for them.
The guide, which draws on scientific evidence to avoid any biases, explains the difference between a mastectomy and a lumpectomy, which have similar success rates in beating cancer. It allows women to consider this tough choice at a time of their choosing. When given the opportunity to make an informed decision, women generally chose the more conservative lumpectomy. Afterwards, patient surveys show they also feel the care they received was better compared to those who did not use the discussion guides.
Across the country, Group Health Cooperative, a health system that covers residents in Washington State and Northern Idaho, incorporated 12 discussion guides across six specialties including orthopedics, gynecology, and general surgery—with phenomenal results. After a year and a half, the surgery rates for hip and knee replacements fell, patient satisfaction was up, and the total cost of care declined.
If medical discussion guides were more readily available for common but complicated health problems, patients would be more satisfied with their care and could avoid getting a more expensive or invasive treatment. So what needs to happen to have more physicians use them?
First, a physician’s time needs to be taken into account since the use of discussion guides will prolong visits. This can be addressed, for instance, by providing incentives for health professionals to offer discussion guides to patients as a routine step in receiving Medicare payment. Second, we can engage health professionals in the shared decision-making process and use of discussion guides by including the tool in continuing medical education and medical school curriculum. And, third, health plans should track and report on whether patients were offered discussion guides in their decision-making process.
There are also avenues for further adoption on the state level. In 2007, the Washington State legislature changed their informed consent laws to expand legal protection from malpractice lawsuits for health professionals who use shared decision-making and discussion guides. There, physicians can follow informed consent requirements in the standard way, but if they use a certified patient decision aid as part of the informed consent process, the physician will receive a higher degree of legal protection from lawsuits by establishing assumed inform consent or “rebuttal presumption.” This measure will encourage physicians to incorporate shared decision making and medical discussion guides into their practice, and can be scaled nationally by mimicking what Washington has done in other states.
It’s difficult to be a patient — whether you’re a professional athlete or just an everyday fan — and it’s clear that we can do more to improve the patient experience and help people make the choice that’s right for them. Having access to proven tools like medical discussion guides could help patients make better decisions, avoid wasteful care, and feel more satisfied with their choice. And these tools happen to save Medicare billions of dollars. Politics aside, that seems to be a slam dunk for members.
David Kendall is the senior fellow for health and fiscal policy at Third Way and Jackie Stewart is senior health advisor to the Economic Program at Third Way. Correction 8 a.m. A previous version of this op-ed misspelled Wade's first name.