Partnership to Improve Patient Care

A new Health Affairs article concludes, based on focus groups and interviews, that "consumers will revolt if evidence-based efforts are perceived as rationing or as a way to deny them needed treatment."

You don't need to look any further than public reaction to the U.S. Preventive Service Task Force's updated recommendations on mammography screening to see the proof of this.
 
How should policy-makers react? Should they conclude that consumers, and even more so, patients, cannot be relied on to make evidence-based decisions, and therefore these decisions need to be made for them? Or should they conclude that evidence-based models of medical care and health delivery need to be carefully constructed so they have the trust and support of patients and consumers?

I'm worried that, based on the article's conclusions, the authors may have missed the point, and done so in a way that implicitly encourages policy-makers to conclude that decisions need to be made for consumers and patients who are not capable of making good decisions themselves. In the conclusion, the authors describe a "communication toolkit" they developed "on the basis of the research we have described." According to the authors, whose work was supported by the National Business Group on Health and others, the NBGH toolkit is "designed to enable employers and unions to communicate with consumers about evidence-based health care..." I'm concerned that the effort misses the point that consumers and patients put great weight on the source of the health care information they receive, because consumers and patients are smart enough to know that every stakeholder in health has different goals and perspectives. A toolkit provided by an employer that highlights "making wise use of money spent on health care," for example, may not be as warmly received by consumers (and patients) as a decision-aid given to them by their physician that gives a clear description of the risks and benefits of different tests or treatment options.
 
Another point from the article worth considering is the finding that very few people report that their doctors take the time to discuss with them the available medical evidence.  This goes to the heart of evidence-based medicine (which the article never defines - perhaps another cause for patients to proceed with caution) -- physician and patient consideration of best available evidence, in combination with the physician's expertise and knowledge of the individual patient's needs and preferences, in deciding what type of medical care to provide. Our health care system simply is not structured to give physicians the time, and patients the tools needed to have these conversations as often as we should. I believe that this, and not consumer skepticism about cost-cutters bearing evidence-based gifts, goes to the heart of the problem.
 
I firmly believe that consumers and patients do support evidence-based medicine if they have assurance that research is being conducted and applied with their best interests at heart and know that the evidence will be used to help them and their doctors make better choices, not dictate those choices to them.
 
Here's the paradox—to get consumers (and patients) to embrace evidence-based medicine, you need to give patients and doctors more control over our health care decisions, not less. As soon patients sense  that practicing evidence-based medicine may be code for access restrictions based on one-size-fits-all "best practices," they will reject it out of hand. Stated another way, put the time and effort into making health care delivery more patient-centered, and you likely will find patients ready to embrace evidence-based approaches to their care.  This will provide the needed foundation for meeting our continued challenges in achieving better quality and value in health care.