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Physicians suggest expert recommendations ignore vital issues for patients
Date:9/12/2012

surgery, radiation or chemotherapy for a larger cancer detected later in life?

"How do we quantify the utility or impact" of these decisions on a man or woman's life?

Hartzband and Groopman note expert groups typically use methods such as time tradeoff or the "standard gamble," that require people to forecast how they would feel in the future should they become ill or suffer complications of treatment.

"But these calculations are profoundly flawed. They require people to imagine themselves in a health state that they haven't experienced. Even we, as physicians who have cared for many patients with a particular condition, find in difficult to accurately imagine what our lives would be like if we were living with that condition ourselves."

Despite the severe flaws in how many expert groups calculate risk and benefit, their recommendations have a powerful impact on patients' care. In the wake of health reform, major policies could be crafted on the narrow criterion of death and using flawed methods of analysis.

"People have a remarkable capacity to adapt to changes. Indeed, when the quality of life is assessed by patients themselves, there is no difference in assessments between men with prostate cancer who underwent prostatectomy and those who choose active surveillance.

There is often as profound disconnect between the way healthy people view medical conditions and the way patients with these conditions view themselves."

Hartzband and Groopman suggest patients and physicians alike not ignore the real complexities and uncertainties of medical choices.

"Wrestling with these uncertainties requires nuanced and individualized judgment. It is neither ignorant nor irrational to question the wisdom of expert recommendations that are sweeping and generic."


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Contact: Jerry Berger
jberger@bidmc.harvard.edu
617-667-7308
Beth Israel Deaconess Medical Center
Source:Eurekalert

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