(To see my original post on cutting back on healthcare spending, scroll down and click on “September 2007”under “Archives” on the left-hand side of the page. You will find my September 12 post a little more than halfway down the page.)

Barbara—

In some cases, patients can and should actively share in decision as to what kind of care they need. For instance, in the case of elective surgery like a knee implant,  the surgeon and  the patients should discuss the risks and benefits. How long will it take to convalesce? How much pain will the patient experience after surgery?  What can he or she expect in terms of improved function?
Is physical therapy an alternative to sugery? I’ll be writing more about “shared decision-making” for elective surgery in the future.

On the other hand, when it comes to picking a particular knee implant, this is a decision that you want your surgeon to make. Research shows that you are most likely to be satisfied with the outcome if your surgeon uses a device that he has used many times  in the past. Practice makes perfect.

Moreover, too often consumers are influenced by misleading advertising. See my post on “Bespoke Knees” below.  Often drug-makers and device-makers advertise a product “directly to the consumer” because they know they would have a hard time persuading physicians of their claims. They just don’t have the medical evidence to back up what they’re saying.

As for the idea
that if patients have “skin in the game” they would make wiser decisions, I’m
afraid that the research shows that this just isn’t true. When co-pays are
high, patients are just as likely to put off getting needed care as they are to
defer unnecessary care. And of course if
they defer care that they need, they will only become sicker—which means that
when they finally are treated, the care will be that much more expensive.