Most of us like it when our health care decisions are simple and straightforward -- when the potential benefit of one option far outweighs the benefits and risks of the other. Should I smoke? No. Should I get a mammogram? Yes. However, advances in screening, preventive measures, diagnostic technologies and treatments have rendered our preference for the certainty of the simple choice obsolete.
In part an effort to recognize our autonomy our right to self-determination and in part to protect our physicians liability, we now are frequently 'informed' prior to consenting to a growing number of tests and procedures.
But, as almost any of us who have participated in informed consent procedures will attest, this is mostly theater. We tend to sign without reading the accompanying material, just as we check the box that we agree to the terms and conditions of using new Web sites without even scrolling through them, despite the fact that both are legally binding.
With each new social problem that emerges, from financial conflicted doctors to predatory lending, the knee-jerk response is increased disclosure. It's cheap, it's easy and it supposedly empowers people to make better decisions. Trouble is, it doesn't work, writes Kai Falkenberg in Forbes in a column about a forthcoming law review article by Carl E. Schneider and Omri Ben-Shahar.
The idea that more information is better for all flies in the face of everything that is known about how people even very skilled ones make decisions.
The same research that documents our aversion to collecting and weighing complex information also suggests strategies that could engage us in making these decisions that can affect our futures. We seem to do a lot better when we have access not only to facts but also to expertise that helps us personalize those facts, place them in context and simplify our choices.
EMMI, a Web-based commercial patient decision support site and the Foundation for Informed Medical Decision Making, a non-profit that funds and disseminates tools for people to use with their provider when making health care decisions both exemplify current initiatives aimed at providing focused information and preparing people to enter into discussions about their options with their provider.
Couple things to think about here:
First, are providers a receptive audience to the conclusions of Schneider and Ben-Shahar: that informed consent prior to health care decisions can't be pawned off onto a tech with good reading skills or a Web site that an in-person discussion is in order if we are to make choices that are consistent with our unique needs and preferences?
And second, will the busy health care environment, where the threshold for action requires that the action reduce costs, improve outcomes or both, be amenable to making sure providers have the time and resources for this activity which does not reliably produce either but can make all the difference in how we view our selves, our doctors and our care in the future?