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Graphic "Maybe we have no idea what we're doing"

Graphic from his original post. Source:

Regular readers may recall SPM member Zack Berger MD PhD’s July post here The pledge of the patient-centered physician. Zack is one of the many SPM members attending the Stanford Medicine X conference this weekend and sends this Saturday night report, cross-posted from his book’s blog.

We’ve often written here about shared decision making, which helps patients choose based on the best available evidence. Here, Zack touches on an alarming but real aspect: what if the evidence is not so good? What have we accomplished? Can we (all) tolerate uncertainty?

I’m at the Stanford Medicine X conference, which provides much food for thought. Here’s tonight’s musings, based on an assumption which is quite prevalent among patient-centered health care folk today (a group I consider myself a member of). The assumption? More data is better.

That’s a red herring. We all know that only the right data, data linked to better health, is actually useful.

How do we get good data into the hands of patients to – among other things – aid their decision making? Decision aids have been much publicized, and for good reason. They are the next step, taking us from the evidence we already know about to the shared decision making we are trying to achieve.

But decision aids are missing something, I think. Take this Mayo statin decision aid, comparing risks and benefits of cholesterol medications for prevention of heart disease.It’s great. I use it all the time. But I’ve been thinking about something.

It assumes that the benefits can be precisely derived from the literature. Yet we know from a recent Annals of Internal Medicine review by Vinay Prasad that the benefits of statins are themselves in dispute.

So we have a risk/benefit balance added to uncertainty. If we are serious about engaging patients, shouldn’t we try and represent that in our decision aids? We can trust them – if providers are ready to do the work.



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