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You deserve answers about the risks, benefits of medical care

Consumer Reports News: May 26, 2009 04:47 PM

Patients who come to my office for lower-back pain are often seeking a second opinion because they’ve been told they need surgery. And as it turns out, many get better by waiting it out, which may explain why 35 percent of our Consumer Reports Health Ratings Center survey of more than 14,000 people with lower-back pain said they never consulted a professional at all.

Others improve with a variety of treatments, especially hands-on therapies. Patient preference plays a big role in healing, regardless of the treatment chosen. If a person is not keen on taking medications, the drugs are not likely to be effective (and prescriptions may not even be filled), and likewise, if someone doesn’t want to make the time for regular physical therapy, its benefits are bound to be limited. The decision that will often work best depends on the patient's own beliefs and values. And the choice that is best for one person may not be best for another under exactly the same circumstances.

Enlisting the preferences of patients is part of helping patients reach an informed medical decision. Shared decision making involves a conversation in which patients communicate their values and the relative importance they place on benefits and harms. It also means doctors make sure that patients understand their therapeutic options. This includes explaining the medical uncertainties.

When it comes to back surgery, outcomes are not always successful, as we discovered by asking almost 1,000 Consumer Reports Online subscribers who had had a back operation in the last five years. In fact, 16 percent of our respondents said that their back pain did not improve, 8 percent said it actually became worse, and more than two-thirds of our sample had two or more problems related to recovery. Perhaps the most astonishing finding in our survey was that more than a quarter of the respondents said they had not been informed about the risks of surgery, such as nerve injury, bleeding, and infection. And that’s scary to hear, because it was the surgeon, we were told, upon whom 9 in 10 patients rely most for information before going under the knife.

After getting these results, we spoke with James N. Weinstein, D.O., M.S., director of the Dartmouth Institute for Health Policy and Clinical Practice, and chairman of the department of orthopaedics at the Dartmouth Medical School and the Dartmouth-Hitchcock Medical Center. He said that it’s unfortunate that shared decision-making and true "informed choice" is not the norm. Patients want and deserve to have meaningful information presented to them about risks and benefits, particularly in cases in which treatment options are a toss-up.

Think about that the next time you go to your doctor. And if you don’t get answers, find another one.

Orly Avitzur, M.D., Consumer Reports medical adviser


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