Where You Are Is What You Get

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By Jill Arnold


From “Improving Patient Decision-Making in Health Care: A 2011 Dartmouth Atlas Report Highlighting Minnesota”, a report of the Dartmouth Atlas Project, whose major funders include the Robert Wood Johnson Foundation, the National Institute of Aging, California Healthcare Foundation, United Healthcare Foundation, and the WellPoint Foundation.


All too often, patients facing the possibility of elective surgery are not given an opportunity to understand their options fully. Many patients are not even aware that the decision about elective surgery is actually a choice and that it should generally be theirs to make. Instead, they routinely delegate such important, even life-altering decisions to their clinicians in the belief that “the doctor knows best.” The result is that patients often do not get the treatment that they would prefer. Research suggests that for many conditions—especially those that can be treated with elective surgery—the treatment a patient receives depends more on the physician’s recommendations than the patient’s preferences.1

Clinicians are not mind readers. They often do not know or ask their patients about their values and preferences; or they may assume that the patient’s values are similar to their own. As a result, they may recommend treatment that is different from what their patients would have chosen had they been fully informed.2,3 Clinicians also vary widely in their opinions about the best course of treatment for any given condition.

These differences in clinicians’ personal beliefs and opinions contribute to the variation in surgical rates in different geographic locations. For example, there is considerable disagreement among surgeons about the need for back surgery, its effectiveness, and even the best way to diagnose the cause of back pain. With no consensus about how to diagnose and treat back pain, the rate of back surgery varies widely from place to place.


PDF of the report