{"id":6352,"date":"2010-12-23T15:46:08","date_gmt":"2010-12-23T14:46:08","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=6352"},"modified":"2010-12-31T11:42:01","modified_gmt":"2010-12-31T10:42:01","slug":"tessa-richards-patients-as-cost-savers","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/12\/23\/tessa-richards-patients-as-cost-savers\/","title":{"rendered":"Tessa Richards: Patients as cost savers?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/tessa_richards.jpg\" alt=\"Tessa Richards\" width=\"160\" height=\"111\" align=\"left\" \/>Might patients hold the key to putting the brake on spiralling healthcare costs?\u00a0 If you had asked me that question a few days ago I\u2019d have said no. We all know about the problem of spiralling demand for healthcare and rising patients&#8217; expectations. But after participating in the <a href=\"http:\/\/www.salzburgglobal.org\/2009\/index.cfm\">Salzburg\u00a0 Global Seminar<\/a>,\u00a0 where the\u00a0 thesis that\u201d better decision making by patients will result in better and cheaper healthcare\u201d was debated,\u00a0 my views have shifted.<!--more--><br \/>\nAll participants agreed that health professionals\u00a0 have an ethical duty to support patients to make informed\u00a0 \u201cshared\u201d\u00a0 decisions, and\u00a0 that they should explore patients&#8217; values and preferences for treatment, although\u00a0 choice is not a luxury that all countries enjoy,\u00a0 as Biao Xu, an epidemiologist from Shanghai underlined <a title=\"BMJ blog\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/12\/23\/biao-xu-shared-decision-making-in-china\/\" target=\"_blank\">in her blog<\/a>.<\/p>\n<p>But in well resourced countries, patients do have options, and evidence presented at the meeting, including the work on choice of treatment for\u00a0 prostate cancer\u00a0 suggests that when they are fully and accurately informed about the benefits and harms of interventions, they opt for fewer treatments. Hence\u00a0 the\u00a0 potential for cost savings.<\/p>\n<p>Several\u00a0 participants\u00a0 dissected the choices and decisions made about their own medical care, and\u00a0 half way I found myself silently interrogating one of mine.\u00a0 Five years ago I opted to have postoperative abdominal\u00a0 radiotherapy, despite the absence\u00a0 of evidence it would reduce\u00a0 recurrence of a rare cancer. The consultant was clear about this but suggested that it made empirical sense.\u00a0 Towards the end of treatment ,\u00a0 when I had boned up on all the risks of undergoing\u00a0 high dose radiotherapy I became alarmed about the trade-off and skipped the last sessions. A good example of a bad and expensive decision?<\/p>\n<p>Many factors influence patients&#8217; choice about treatment, foremost among which is the ability and readiness\u00a0 of doctors to offer it.\u00a0 But this varies from region to region and unit to unit and needs to be confronted and unpicked (<a title=\"BMJ article\" href=\"implications for academic medical centres\" target=\"_blank\">read BMJ article by Jack Wennberg<\/a>).\u00a0 \u201cSupplier induced demand\u201d is a reality,\u00a0 that doctors and patients need to be much more aware of.\u00a0 One way to counter this is to ensure that decisions on management are fully shared and informed, the\u00a0 \u201cnothing about me without me \u201dagenda. Patients need\u00a0 comprehensive accurate and up to date information about the benefits and harms of treatment (and\u00a0 high quality decision aids help) and their preferences and values taken into account\u00a0 (<a title=\"BMJ article\" href=\"http:\/\/www.bmj.com\/content\/339\/bmj.b4073\" target=\"_blank\">read BMJ article by Albert G Mulley<\/a>), not least on decisions about end of life care. These messages came over loud and clear from the\u00a0 authors of these two seminal BMJ papers , Jack Wennberg and Al Mulley,\u00a0who\u00a0cofounded the Foundation for\u00a0Informed Medical Decision Making, which supported the symposium.<\/p>\n<p>Doctors&#8217; enthusiasm to offer treatment to patients is\u00a0 fuelled by the publication of papers that are optimistic about its value.\u00a0 Medical journals clearly have a pivotal role here. I shrank in my seat as I listened to a\u00a0 barrage of criticism about the\u00a0 way journals propagate misinformation, and fan the daily tsunami\u00a0 of hype ridden\u00a0 health stories in the media.\u00a0 Editors need to get much better at tackling publication bias (towards studies with positive results),\u00a0 misleading communication of risk (<a title=\"BMJ article\" href=\"http:\/\/www.bmj.com\/content\/341\/bmj.c4830\" target=\"_blank\">read BMJ article by Gerd Gigerenzer et al<\/a>), letting authors get away with spin, and reproducing this in press releases.<\/p>\n<p>This was my main take home message, and in the linked blogs below you can read what other\u00a0 participants took away from Salzburg, where snow doesn\u2019t\u00a0 disrupt\u00a0 services and the Sound of Music is everywhere,\u00a0 and\u00a0 the vision of realising best practice can be seen.<\/p>\n<p><em><strong>Tessa Richards<\/strong> is analysis editor, BMJ.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Might patients hold the key to putting the brake on spiralling healthcare costs?\u00a0 If you had asked me that question a few days ago I\u2019d have said no. We all [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/12\/23\/tessa-richards-patients-as-cost-savers\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1751],"tags":[1904],"class_list":["post-6352","post","type-post","status-publish","format-standard","hentry","category-tessa-richards","tag-salzburg-symposium"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Tessa Richards: Patients as cost savers? - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/12\/23\/tessa-richards-patients-as-cost-savers\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tessa Richards: Patients as cost savers? - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Might patients hold the key to putting the brake on spiralling healthcare costs?\u00a0 If you had asked me that question a few days ago I\u2019d have said no. 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