Earlier this year, Atul Gawande published a New Yorker piece called “Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?”
He cites medical evidence that millions of Americans get tests, drugs, and operations that won’t make them better, may cause harm, and cost billions. As an emergency medicine provider, I understand the impetus for this–as Gawande notes: “as a doctor, I am far more concerned about doing too little than doing too much. It’s the scan, the test, the operation that I should have done that sticks with me—sometimes for years.” We are only held accountable for the tests or meds we should have ordered, rather than those we did.
After reading Gawande’s piece, I have asked more patients and friends about whether they or their family member had experienced something they thought was unnecessary tests or care, and many had. It is a conversation I have more often with patients and their families, when the need to test or intervene is not emergent (for example, a child who has stopped breathing). There are plenty who still request that I make the decision for them–a more paternalistic model of medical decision-making, and, frankly, the model I was trained to follow in my early medical education. They say that being offered the chance to participate in the decision makes them nervous.
But it seems a growing proportion are eager to be engaged in their decision-making, and even come equipped to participate, with Google searches in-hand. A recent photo circulating on social media makes fun of the Google-informed patient. As time-consuming as shared-decision-making is, for the patients who want to engage in it, to do otherwise is not patient-centered.
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