Take Charge of Your Life! - - - The Class Panel for reunion 2016 was organized by Dr. Mariel Harris.  This article is under construction. Check back soon for more from panelists at the talk.

Part One:

westcottOur first speaker describes herself as a patient educator and advocate. She is Pamela H. Wescott, MPPDirector, Patient Perspectives Research at Healthwise/ Informed Medical Decisions Foundation.


Here are Pam's notes from her talk on Informed Medical Decision Making

Good morning.  First, a story to present the problem we are trying to address:

It’s Father’s Day. Home Depot. Three men are picking out their Father’s Day tomato plants.  I hear…

My artery was blocked 85%! The stent saved my life.

I had two stents! Blocked 65% and 45%!

I’m sure I’ll need a stent soon given all the bacon and eggs I eat.

When we talked to 43 patients in Maine, Hanover, NH, Boston and San Diego, only 3 out of 43 had made an informed decision.  They were all scared.  Most were not told that medications could help as well or better. All were grateful that the stent stopped the chest pain and gave them back their energy.

We know that stents relieve the symptoms of chest pain, help you stay active.  But studies show that medications, not the stent, will prevent future heart attacks.

If given the choice, some people could NOT go through the procedure, and try medications, first. 

25 years ago, The Informed Medical Decisions Foundation was created to educate patients about the fact that they have a role to play in making the medical decisions that affect them.

Jack Wennberg, a researcher at Dartmouth Medical School had 4 children and noticed that the tonsils –of his kids and their friends--were being treated differently on two sides of the river. He figured out that two physicians were treating them differently—one leaving tonsils in, one taking tonsils out.

Jack went on to create the Dartmouth Atlas which compares the rates of tests, procedures, treatments in different regions of the country.

A good example: is back surgery. He found if you live in Wyoming or Florida, you are more likely to have a physician recommend back surgery than if you live in Vermont or Massachusetts.

For herniated discs, studies show you have a choice. In 3 years, you will be in the same place in terms of pain and function—whether you have surgery or do nonsurgical treatments.  Some people prefer to feel better sooner, and opt for surgery. Others prefer the nonsurgical path—physical therapy, strength-training, dealing with flare-ups as they occur.

Jack Wennberg started the foundation and identified the solution of Shared Decision Making. 

This means learning the pros and cons of the different options, thinking about your goals and concerns, discussing with your doctor, and making the choice that feels best for you.

Two more examples:

  • Taking medications for Osteoporosis—People view numbers differently: 10-40 in 100,000 broke thighbone, 1 out of 100,000 had disintegrated jawbone. Some say “no way”…for others “not a problem.”
  • There’s sometimes a need to communicate what’s important when having a procedure.  One woman had a mastectomy and wanted surgical team to know the most important thing in her life was playing the bagpipes.  They needed to know when removing her lymph nodes.

Often physicians don’t have time and decision aids can help— (prescribed at MGH, Dartmouth, Group Health in Seattle, short forms called decision points in many places.  Ask what’s available.

And I want to close with the words of Atul Gawande who wrote Being Mortal:

  • We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival.  But really it is larger than that.  It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life or when debility comes, but all along the way. What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the tradeoffs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

 

As part of our class panel discussion, “Take Charge of Your Life,” I discussed informed medical decision making. Here is a link to a very useful 15-minute video on YouTube. You can hear the rationales of 4 people who made informed medical treatment decisions to manage their conditions. Click on the link:

https://www.youtube.com/watch?v=Cna__dMxcko

Also linked is a Patient Visit Guide—to help you think through the pros and cons of any medical decision.

Here is another article classmates might find useful called SDM in the Golden Years by Mary McNaughton Collins, M.D.

Any questions?  Please let me know at phwescott@gmail.com