May/June 2008 Annals of Family Medicine...(to multiple stakeholder groups may make ...),Health

Physician Responses to a Community-Level Trial Promoting Judicious Antibiotic Use
By Christopher J. Stille, M.D., M.P.H., et al

Using patient stories, a family physician elucidates the magnitude of the U.S. health care crisis, describing problems at all levels of the system from financing structures to the current delivery system. Invoking the need for individual responsibility, she encourages fellow clinicians to be proactive and lead meaningful change.

The Unsustainable US. Health Care System: A Blueprint for Change
By Jennifer DeVoe, M.D., D.Phil.

When conveying important information about the benefits of a medication to patients, pictures appear to be more powerful than words. A study of 100 patients with cardiovascular disease finds that 57 percent prefer information about the risks and benefits of treatment be presented graphically. Other ways of expressing risk and benefit were less popular among study participants. Only 19 percent preferred information expressed as relative risk, 13 percent preferred absolute risk, 9 percent preferred natural frequencies, and only one patient preferred the information be presented in terms of an odds ratio. Notably, no patients preferred number needed to treat, a method for communicating risk and benefit that is very useful to clinicians. The authors assert that these findings support the need for the development of visual aids to support shared clinical decision making.

An accompanying editorial by Spiegelhalter highlights one of the essential elements of primary care living with uncertainty and explains why there is uncertainty both for doctors and patients. He explains that physicians attempts
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