Patients as partners. People with complex and even life-threatening medical problems often handle them this way: The doctor diagnoses a condition and recommends a treatment, and the patient complies. Now institutions like Massachusetts General Hospital in Boston, Dartmouth-Hitchcock Medical Center in New Hampshire, and Mercy Clinics in Iowa are adding a step to the process. They're educating patients about their options, and asking them what they think. "I felt I had a choice," says David Wunsch, a Belmont, Mass., retiree who was referred by his Mass General primary care doctor to an orthopedic surgeon last March after the pain in his left knee became "intolerable." The doctor also e-prescribed a video highlighting the pros and cons of different knee pain treatment options, from pain shots to full knee replacements.
"Shared decision-making" formalizes a partnership between patients and their providers, says Leigh Simmons, co-director of Mass General's program. Jointly, they make the call on treatment paths, taking into account both the scientific evidence and the patient's values and preferences. The hospital's electronic medical records system prompts doctors when a treatment decision needs to be made for one of 35 conditions, reminding them to order educational DVDs for patients through a Netflix-type system and to invite the patients to bring up any questions. Dartmouth-Hitchcock has a shared decision-making center where patients can discuss options with staffers and consult educational aids. Mercy Clinics' health coaches meet with patients to distribute resource material and answer questions; patients then meet with their healthcare providers to plot the right path.
Wunsch watched his video and got a better understanding of his options and what surgery would entail. He opted to get his left knee replaced this spring.