Pauline W. Chen: A Surgeon's Reflections

Treating Patients as Partners, by Way of Informed Consent

Informed consent is an integral part of a physician's practice. But for years, I, like most physicians, bumbled through the process, learning by trial and error. I'd like to believe that over time I've gotten better at obtaining consent, but occasionally I'll recall awkward experiences and cringe at the memory.

This week, a study published in the current issue of Academic Medicine made me reflect again on the process of informed consent. Researchers at the Cleveland Clinic found that after a single day-long training session, doctors were better at eliciting questions and clarifying comments than doctors who had not been trained.

In this week's "Doctor and Patient" column, I write about the process of informed consent and how it can strengthen the patient-doctor relationship. How has informed consent affected your relationship with doctors or patients? Can we or should we approach the process differently? Please leave your comments below or on Tara Parker-Pope's "Well" blog.

Getting Good Value in Health Care

Apologies for the dearth of posts lately!

In this week's "Doctor and Patient" column, I look at the economic argument for preventive care. Whenever I see a patient, questions scroll down my mind's eye like credits at the end of a movie.  Some of the questions I ask are generic: What brings you here today? What medications are you taking? Some are specialized: Was your liver transplant done "piggy back"? Have you had any episodes of rejection?  But a few of the questions have nothing to do with the work I do or the care I am trained to offer. Rather, they are questions about being well and preventing disease: Are you exercising? Do you smoke? Have you had a mammogram?

For years I believed that asking questions about a patient's health behaviors or about screening tests was like doing a good deed. The discussion could help a patient avoid preventable diseases and could potentially contribute to the greater public good by saving money and health care resources. 

But it turns out that at least one of my assumptions about preventive medicine -- that it could help save money – was erroneous. Sort of.

Most data shows that preventive medicine does not save money. But in a recent Journal of the American Medical Association commentary, Dr. Steven H. Woolf, a professor of family medicine at Virginia Commonwealth University in Richmond, VA, and a leading expert in preventive medicine, argues that we should not be evaluating preventive interventions by how much money is saved. Instead, we need to look at the value gained for each dollar we spend.

 In this week's "Doctor and Patient" column, I write about these issues and interview Dr. Woolf. Do you think preventive medicine is important? Or do savings trump value? Please leave your comments below or at Tara Parker-Pope's "Well" blog.