Physicians should have access to better information on health
care services and pricing and thus make better choices. Maybe?
By Scott Wooldridge | July 10, 2019 at 01:04 PM
It was a common theory at the beginning of
this age of information: just give people the facts, and they’ll make the right
choice.
We all know how that works out, at least
sometimes. And a new
study suggests that even with physicians, who should know
more about health care than the vast majority of the population, better
information doesn’t always lead to better decisions.
The study, from the National Bureau of
Economic Research, compared physicians to patients when it comes to making
personal health decisions. The study noted that with many health improvement
efforts, patient education is considered a decisive factor.
“There
is a widespread belief in health care that the deficiency in information and
medical knowledge among consumers is the key barrier to achieving high-quality
health outcomes and lower costs of care,” the authors write. “An enormous
number of health policies follow from this assumption, including efforts to
educate patients about health, both at a population level through large-scale
public health campaigns (e.g., campaigns to encourage exercise and healthier
diets) and at an individual level through provider-led patient education (e.g.,
education of patients about the inappropriateness of antibiotics for the common
cold, the importance of vaccination, etc.).”
Doctor knows best?
The researchers started with the theory that
physicians would have much more access to, and familiarity with, high-quality
information when it comes to health care. The study aimed to test the upper
boundaries of how information plays a role in health care choices, the
researchers said, since most members of the general public were not likely to
be better informed than physicians.
Using a military database that covers active
service members; their families; and retirees; and was able to identify
patients who were also physicians, the study looked at ten years of data. The
researchers assessed whether patients received “high-value” or “low-value”
services.
“An example of low-value care is a chest X-ray
before eye surgery, a very low risk procedure for which pre-operative
diagnostic testing is not recommended,” the study said. “An example of
high-value care would be statin therapy for patients with cardiovascular
disease.”
Mixed results
The researchers say that in many cases,
physicians did not make significantly different choices than less-educated
patients.
“Our results suggest that physicians do only
slightly better than non-physicians—but not by much and not always,” the study
said. “Across most of our low-value settings, physicians receive less low-value
care than do non-physicians, but the differences are modest.”
The study said it’s likely that factors other
than information may play a large role in health care decision-making. For
example, they suggest that high-information physicians make low-value choices
in some cases because of time pressures. In addition, the study suggests that
physician patients, just like non-physician patients, seem more likely to
follow the recommendation of their health care provider, even when that
recommendation falls into the low-value category.
The study is a working paper that has not yet
been peer-reviewed; and while the authors acknowledge that their findings have
some limitations, they say that the report suggests there may be limits on the
benefits of patient education.
“Our results consistently suggest that, at
most, superior patient knowledge is associated with only modest improvements in
the quality of care selected through medical encounters,” the study concludes.
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