I’m speaking this morning at the Summer Institute for Informed Patient Choice. It’s a big-deal event in the world of Shared Decision Making (SDM), a topic I’ve written often about on this blog and on e-patients.net.
Here are links to resources mentioned in my talk.
- TEDx videos: “Who can fix health care? Let patients help.” It amazes me that the two of us knew nothing about each other’s talk, but these talks fit together as if they were choreographed:
- Engagement Behavior Framework from the Center for Advancing Health (CFAH). This model, announced in May, is valuable as our movement grows: “Okay, we agree that it’s good to have engaged patients. What specifically does that mean? How can we get to work?” CFAH’s framework answers it:
- “The burning platform” – the urgent case for action: the Kaiser Family Foundation’s graph of health costs vs employee wages. (Thanks to the American Board of Internal Medicine Foundation for drawing my attention to this chart.)
- No matter what’s the cause of this trend, it’s inexorable and it’s deadly: it’s driving more and more people to be uninsured (50 million in the US) and more and more people to have high deductible health plans.
- And no matter what happens as the US health reform bill rolls out, somebody, somewhere will be paying these costs. The costs are the problem and the costs are real.
- SDM has been shown repeatedly to reduce costs overall – for whatever reason, well informed patients usually choose less invasive, less expensive options.
- More to the point, though, as more and more decisions are pushed onto the consumer / patient, we must equip them with the information to make informed decisions. Otherwise they’ll be making … uninformed decisions. And that won’t help anyone.
- Look at that cost curve again. Do we really want less informed decision makers driving that truck? That would be called “out of control.”
- 15,000 accidental Medicare deaths per month – a good solid blog post about the Inspector General’s report, Nov. 2010, publishing this result.
- Yes, Medicare patients have a 1 in 70 chance they’ll die accidentally while hospitalized for anything.
- The report also found a 1 in THREE chance of significant accidental harm.
- In my view, any SDM process must take into account the strong risk of accidental death or harm. How else can we compare that against the option of “watchful waiting,” i.e. don’t hospitalize yet, maybe later?
- Look at it this way:
- Imagine you’re on one side of a canyon, and you’ve got a problem to solve, and the solution is on the other side.
- To get there, you ride a gondola. No problem, right? A little wobbly and scary – like being hospitalized – but you can handle it.
- Now imagine you learn this: 1 in 70 passengers falls to their death, and 1 in 3 is injured en route.
- Kinda changes your consideration about whether to hop on board, eh?
Can any treatment decision be fully informed without full awareness of this?
As I always say: I was saved by great healthcare, including clinicians who at every opportunity encouraged me to be fully informed and fully engaged. It didn’t go perfect, but it went well. All I want is for every man, woman, child and elder to have the same shot at damn good healthcare. And I say, that requires informed medical decision making.