Monday, 9 June 2014

The informed medical decision making








In this post, I’ll discuss some initiatives that began in the U.S. long before the emergence of the internet, but now, with the explosion of communication channels and social networks, these have taken on an impressive dimension that I’d like to bring to your knowledge and appreciation because, as we stand today in our environment, we are very far from these advances.

Healthwise is a U.S. company offering all kinds of solutions helping healthy people to better preserve their health and patients to better understand their disease. Many assurances, such as Kaiser Permanente, are offering Healthwise products and solutions to their members, with the aim of supporting policies of empowerment.

http://www.healthwise.org/video/sdp.aspx

Summary of video content

Healthwises’ material claims that if the patients’ decisions are as informed as possible according to each person’ values, then the costs will be further reduced and the outcomes of clinical interventions improved. The video is an example of how, in 6 steps, patients have the opportunity to see details of the scientific evidence that allows them to compare the options, see other cases that have already gone through the same process and finally have the option to think freely about their preference.

Informed Medical Decision Making Foundation. This U.S. private foundation was created over twenty years ago in order to offer a platform to quieten down the doctors’ influence, especially that of surgeons’ in clinical decisions (see post February 21th). John Wennberg had already demonstrated in his studies the strong variability of surgical practice, even in the simplest interventions (see The Dartmouth Atlas in the U.S. or VPM Atlas in Spain) and was himself one of the promoters of this foundation.

http://vimeo.com/35274883


Summary of video content

In this video, two patients explain the materials offered by the foundation, while several doctors (urologist, internist, family doctor, paediatrician, and physiotherapist) talk about the advantages of having patients equipped for better decision making, which, they say, involves patients more in the clinical process.


Discussion

Talking about informed medical decision making, the Spanish situation is far from the American dynamics, where the private sector has managed to offer patients very well crafted informative packs based on comprehensible scientific evidence, recommendations from other patients and spaces for reflection. According to the latest Cochrane Collaboration review, these are demonstrating that patients who practice informed decision making, end up opting for the more conservative clinical practices, which in some pathologies can potentially reduce the surgical procedures by up to 20%. There is even a King’s Fund publication that reveals the clinical decisions made with a “partially” informed patient as “the silent misdiagnosis”.

If we surf the web pages of the Ministerio de Sanidad, Servicios Sociales e Igualdad and Canal Salut de Catalunya, we find extensive information aimed at citizens regarding health prevention and symptoms and diseases management, but we see no sign of any material that can help the decision making process. Despite this, I don’t see this gap especially disappointing because I think this is an initiative that should be expected to come more from the community level and not from the administration. But if we click on the "Foro Español de Pacientes” website we fail to notice that the support tools for informed medical decisions making are on the agenda.



Jordi Varela
Editor

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