Prescription for the Future by Ezekiel J. Emanuel

Author:Ezekiel J. Emanuel
Language: eng
Format: epub
Publisher: PublicAffairs
Published: 2017-06-06T04:00:00+00:00

Often times a patient just goes to the PCP, then gets sent right to the surgeon, and they get scheduled for surgery. And they never really wanted to have surgery in the first place.… They tell us, “I didn’t want to have surgery. I just wanted to feel a little better, maybe some pain medications.” But no one really takes the time to explain the risks and benefits and sit down with them. They’re just shuffled from PCP to surgeon to the operating room.

CareMore did try formal decision aides and videos but saw only mixed results with their elderly population. Ultimately, they chose to do without such aides: “Instead, we come in and talked to them on an individual, a personal basis, explaining what the statistics are. That is actually key for our model of care—bonding with the patient rather than using forms and videos.”

Ensuring true informed consent and shared decision making has another advantage—time. In many of these cases, especially back pain, knee pain, and other interventions done for pain relief, time itself can be a therapeutic intervention. Not only did CareMore lengthen the process by requiring the pre-op visit to be linked to the acquisition of informed consent, but it also partnered with a chiropractic college to provide chiropractic, acupuncture, and other services to their back pain patients:

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