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First MacLean Center Prize in Clinical Ethics awarded to Dartmouth's John Wennberg
Date:11/16/2011

th Professions in the U.S. Department of Health and Human Services, described Wennberg as "both the Christopher Columbus and the Johnny Appleseed of clinical variation," meaning he not only discovered the field but also brought it to the attention of the medical and health policy communities.

At the ethics conference, after noting that "when you get paid so much to give a lecture, you get a little nervous," Wennberg spoke about the early days of the Atlas and how these studies of practice variation in the mid-1970s "challenged the notion that science was driving utilization."

Instead, he found that decisions about surgical treatment for benign prostate hyperplasia revealed what the researchers called "surgical signatures," patterns of practice based on the beliefs of individual surgeons or surgical groups.

Wennberg's team developed short videos that explained the risks and benefits of surgical treatment, including taped interviews with two physicians who had made different decisions. After patients watched the balanced videos, the number who chose surgery declined.

"This was the first evidence," he said, "that engagement of patients could lead to the right utilization rate."

Only about 25 percent of medical care turns out to be so "preference-sensitive," however, forming what Wennberg calls "little islands of rationality."

Studies of end-of-life care found a far more limited role for shared decision making between patients and their caregivers. These decisions appear to be driven by supply rather than patient preference. Empty hospital beds and unused health care capacity strongly correlate with increased medical attention late in life. For example, more than twice as many patients at UCLA Medical Center as at Dartmouth were admitted to an intensive care unit in the last six months of life.

To close his talk at the ethics conference, Wennberg described his four goals for end-of-life care over the next
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Contact: John Easton
john.easton@uchospitals.edu
773-795-5225
University of Chicago Medical Center
Source:Eurekalert  

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First MacLean Center Prize in Clinical Ethics awarded to Dartmouth's John Wennberg
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