January 15, 2015
By Margie Coloian
Harlan Krumholz, MD wants to dispel two widely believed myths about healthcare: that more of it is better, and that the costliest is the highest quality. Too often patients are not aware of all the healthcare choices that are available to them and the reasonable range of decisions that could be made.
What patients might not realize is that every choice has a set of pros and cons—and that even screening tests can result in downstream risks. And costs do not necessarily have the expected bearing on quality. Unfortunately, many patients end up making choices—deciding to undergo tests and treatments—that they wouldn’t have chosen had they been provided with thorough information, including all their options.
“We need to make sure that patient choices are aligned with their goals, and that we accommodate a wide range of choices,” says Krumholz, director of Yale-New Haven Hospital Center for Outcomes Research & Evaluation, and a keynote speaker at the upcoming Lown Institute third annual conference in San Diego. “For me, it’s all about creating dialogue with patients, placing the patient in the center of decisions. That’s not happening; our whole system is not set up so that patients can participate in informed decision-making.”
Why don’t doctors and other healthcare professionals explain their options to patients, and in ways they can understand? Krumholz surmises that it may be “against the rapid transactional nature of the current system,” a structure that makes it difficult to explain all options a patient has, which is a time-consuming task. Moreover, there is a paucity of tools to help healthcare professionals present treatment options that are precise, personalized and fit for the context of each institution. Furthermore, physicians are not well-trained to provide patients in how best to foster high quality decisions.
“Patients are at a great disadvantage with regard to information essential to decisions and a process that facilitates these decisions,” he says. “They are not put in a position of being able to make well-informed choices about their care, so there is little opportunity for them to exert autonomy,” he said.
How can that change?
“We need to change the culture of medicine. We need to restructure the system. We need to make decisional quality an important goal of medicine,” he insists.
The conference will be a breeding ground for generating fresh ideas for doing so, and some of that work should include developing tools that will assist sound patient decision-making, he added.
“I want to learn from others at the conference,” Krumholz says. “I want to hear others’ ideas on how we can move healthcare to become patient-centric: how we can help patients make the best decisions for them without imposing our physician values on them. I hope there will be breakthrough ideas put forth at the conference.”