Dying at 75, more shared decision making, and rampant C-sections in Brazil: RightCare Weekly

September 25, 2014

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.


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  • The most provocative article this week is from Ezekiel Emanuel, MD, for his piece in The Atlantic on “Why I Hope to Die at 75.” The article is​ a compelling narrative of how American end-of-life care causes suffering for patients and families, yet hasn’t provided the extra years of vibrant and active life that it promised. Emanuel’s personal priorities and hopes for his life: to be remembered as vital and active, and to avoid the decline he sees as synonymous with extended aging.


Many people will disagree with Emanuel’s ideas about what makes life worth living, but they needn’t feel threatened by them, either. Having a system that provides right care means, among other things, that he and others who share his beliefs​ should be allowed to exercise personal preferences. At the same time, people who want their life extended as much as possible have the opportunity to exercise theirs.



  • A new IOM paper calls for the expanded use of shared decision making as an essential component of improving healthcare delivery. Shared decision making is a stronger form of collaboration between caregivers and patients, and involves helping patients understand all their medical options as well as their own values and preferences. Substantial research has shown that patients given access to decision aids, which are commonly used in shared decision making, make better-informed decisions that are better aligned with their values. Lown Institute Senior Vice President Shannon Brownlee is among the authors of the paper.


Vikas Saini, MD, president of Lown Institute, believes that we need a healthcare system in which shared decision-making is embedded in the habits and culture of all concerned — and while decision tools are wonderful technical aids, we should all keep our eyes on that ultimate prize.



  • Medical culture and traditional sexual mores are cited as the reasons that pregnant women in Brazil undergo C-sections at an alarming rate. In private hospitals, some 82 percent of births are by C-section, and in public hospitals, nearly half are. In her piece in The Atlantic, writer Olga Khazan quotes Simone Diniz of the University of São Paulo on why doctors, and sometimes patients, prefer surgical births. “Childbirth is something that is primitive, ugly, nasty, inconvenient. It takes long, and the idea is we have to make it fast…there’s a sense that you need to either accelerate it or do a C-section.” The WHO has, until recently, recommended that C-sections be limited to only 15 percent of all births.


Those of you who attended our last Lown Conference may remember that Paulo Borem, MD, shared the results of a remarkable project in Brazil that reduced C-sections by half in a short time. The secret: systematic education and engagement of both providers and patients. In other words, a multi-pronged effort to change the culture of medical practice work.





We closed applications for our Young Innovator Grants on Sept. 12, and we’re thrilled with the response we received. Thank you to all who applied! Read about the proposals in our infographic.


If you’re enjoying what you read in RightCare Weekly, we hope you’ll get more involved in the RightCare Alliance! Come to our first regional conference, October 11 in Denver, CO, or email for information on hosting your own event!





  1. A Cancer Battle We Can Win – Andrea McKee and Andrew Salner, New York Times op-ed
  2. 21st Century Snake Oil – Stephen Smith, MD, MPH, Community Catalyst PostScript blog
  3. New Thinking About Treating CancerThe Diane Rehm Show, featuring Shannon Brownlee, Louis Weiner, MD, and Jerome Groopman, MD
  4. F.D.A. Panel Backs Limits on Testosterone Drugs – Sabrina Tavernise, New York Times
  5. Finding Risks, Not Answers, in Gene Tests – Denise Grady and Andrew Pollack, New York Times



  1. Hospitals and Insurer Join Forces in California – Reed Abelson, New York Times
  2. FTC wary of mergers by hospitals – Robert Pear, New York Times
  3. Avoid The Rush! Some ERs Are Taking Appointments – Anna Gorman, NPR



  1. Medicaid Gives the Poor a Reason to Say No Thanks – Aaron E. Carroll, The Upshot
  2. How To Fix Medicare? Ask The Public – Mary Agnes Carey, Kaiser Health News
  3. One-Quarter Of ACOs Save Enough Money To Earn Bonuses – Jordan Rau, Kaiser Health News
  4. How do we know ACOs improved quality? – Austin Frakt and Ross White, The Incidental Economist


Shared decision making

  1. Shared decision making: what do clinicians need to know and why should they bother? – Tammy Hoffman, et al., Medical Journal of Australia
  2. Screening For Disease Where No Symptoms Exist – Joseph Hooper, Men’s Journal
  3. Drugs: Effective for the Few, Prescribed to the Many – Joseph Hooper, Men’s Journal
  4. Surgeries You May Be Better Off Without – Joseph Hooper, Men’s Journal


Dementia care

  1. Elder advocates raise concerns on assisted living – Kay Lazar, Boston Globe
  2. Nursing homes vow to cut antipsychotic use in dementia patients – Elsie Viebeck, The Hill


Choosing Wisely

  1. Hospitals Cut Costs by Getting Doctors to Stick to Guidelines – Jeanne Whalen, Wall Street Journal


Patient safety

  1. The Distress of Waking Up Under Anesthesia – Julie Beck, The Atlantic
  2. The Famous Can Present a Minefield for Doctors – Anemona Hartocollis, New York Times


Medical tech

  1. Can a Computer Replace Your Doctor? – Elisabeth Rosenthal, New York Times
  2. No Time To See The Doctor? Try A Virtual Visit – Anna Gorman, Kaiser Health News
  3. Gynecologists Resist FDA Over Popular Surgical Tool – Jennifer Levitz and Jon Kamp, Wall Street Journal
  4. Insurers Hesitant To Cover Many Proton Beam Therapy Treatments – Michelle Andrews, Kaiser Health News


Payment system

  1. After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Know – Elisabeth Rosenthal, New York Times
  2. How Much Does That X-Ray Cost? You Can Find Out In New Hampshire – Julia Appleby, Kaiser Health News
  3. How Insurers Are Finding Ways to Shift Costs to the Sick – Charles Ornstein, The Upshot


Healthcare system

  1. Why I’m Becoming a Primary-Care Doctor – Mara Gordon, The Atlantic
  2. To Get More Out of Science, Show the Rejected Research – Brendan Nyhan, The Upshot
  3. A Health Care Success Story – Bob Kocher and Farzad Mostashari, New York Times op-ed
  4. Reflections on being a patient – Leigh A. Fredholm, MD, Hospitalist News Palliatively Speaking blog
  5. How much money do we waste on useless health care? – Sarah Kliff, Vox


The Right Care Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.