PHILADELPHIA Anyone who has ever tried to set up an internet account or wants to make a purchase on a companys website, has experienced the default option, an event or condition that will be set in place if no alternative is actively chosen.
In an opinion article in the September 28 issue of the New England Journal of Medicine, lead author Scott D. Halpern, M.D., instructor of Epidemiology in the Department of Biostatistics and Epidemiology at the University of Pennsylvania School of Medicine, and colleagues, argue that these concepts applied by marketers should also be used by the medical community to benefit patients. Additional authors are Peter A. Ubel, M.D., and David A. Asch, M.D., M.B.A. When designed properly, the authors write, default options can achieve three goals:
The authors cite examples of potential default options that are easily implemented and would result in an overall benefit. A policy to remove urinary catheters in hospitalized patients after 72 hours unless physicians or nurses document a reason for maintaining them, could reduce the hospital-borne infections.
Organ donations are another example. The change from opt-in to opt-out policies has increased donation rates in many European countries, the authors note.
According to Halpern, who is also a fellow in the division of Pulmonary, Allergy and Critical Care Medicine in the University of Pennsylvania Health System, the current system allows defaults to be set haphazardly. Instead, physicians and policymakers have a great opportunity to set defaults in ways that help to improve the health of individual patients as well as our entire health-care system.
Sometimes default options should not be used, however, and the authors note that these circumstances also need
|Contact: Nan Myers|
University of Pennsylvania School of Medicine