date: 8/9/2005
Controversial health choices: You decide
Patients need to take an active role in controversial health-care decisions.
When you need to make important decisions about your health, you need information from experts who have your interests in mind--just the facts, no drug company advertising. ConsumerReportsHealth.org is your essential source for trusted, unbiased, independent health information, 24 hours a day, 7 days a week.
Patient preferences are a key component of any medical decision, says Beth Nash, M.D., medical adviser to the Consumer Reports Health and clinical editor of the BMJ Publishing Group. Patient desires must be balanced with the two other key components involved in decision making: the published evidence on how to best treat the problem, and the doctor's clinical experience and judgment. In fact, the less conclusive the published evidence for any one course of treatment, the more important the doctor's and patient's judgments become.
"Unfortunately, in too many of those cases patients aren't actively involved in the decision making and, instead, it's left almost entirely up to the doctor," says Nash.
For example, the best treatment for prostate cancer--surgery or radiation--is controversial. Men must weigh the uncertain possibility that removing the prostate might yield a longer-lasting cure against surgery's somewhat greater trauma and risks. But numerous studies have found that the actual choice depends mainly on whether the patient sees a urologic surgeon or a radiation oncologist.
Other research shows that when doctors involve patients in the decision by educating them about the options, patients often make choices that differ from what their doctor typically recommends. For example, well-educated patients are less likely than others to undergo mastectomy, coronary bypass surgery, or operations for benign prostate enlargement, or to be screened for prostate cancer.
Other notable areas where the optimal approach is controversial and your educated preferences should weigh heavily include the following:
"Unfortunately, in too many of those cases patients aren't actively involved in the decision making and, instead, it's left almost entirely up to the doctor," says Nash.
For example, the best treatment for prostate cancer--surgery or radiation--is controversial. Men must weigh the uncertain possibility that removing the prostate might yield a longer-lasting cure against surgery's somewhat greater trauma and risks. But numerous studies have found that the actual choice depends mainly on whether the patient sees a urologic surgeon or a radiation oncologist.
Other research shows that when doctors involve patients in the decision by educating them about the options, patients often make choices that differ from what their doctor typically recommends. For example, well-educated patients are less likely than others to undergo mastectomy, coronary bypass surgery, or operations for benign prostate enlargement, or to be screened for prostate cancer.
Other notable areas where the optimal approach is controversial and your educated preferences should weigh heavily include the following:
- Whether to treat osteoarthritis of the hip or knee with drugs or with surgery.
- How to treat hepatitis C, thyroid cancer, and women's sexual dysfunction.
- Whether, when, and how to screen for ovarian cancer in women and lung cancer in smokers.
- Whether to screen for certain genetic diseases in people with strong family histories of those disorders.
- Whether to measure and what to do about new coronary risk factors, such as arterial calcium deposits, C-reactive protein, and homocysteine levels.
- Whether to use medication in people who have mild diabetes or a high risk of developing it.
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