Thomas H. Ebert, M.D.
Tips for the Best Health Care Experience and Outcome
From the GIC Winter 2016 Newsletter
Guest Editorial by Thomas H. Ebert, M.D., Chief Medical Officer, Fallon Health
All around us there are subliminal messages that new and more is better than old and less. That message permeates consumer directed advertisements for new cars, appliances, and, more ominously, new medications or medical procedures. Physicians regularly must modulate patient expectations and, conversely, patients must interpret physician recommendations about these new treatments.
The GIC has worked tirelessly with its health plans to institute the Centered Care Program and has developed alternative payment strategies with network providers to reward better outcomes and higher quality in a health care system that currently financially rewards performing more services. A hallmark of Centered Care is shared decision making between the provider and patient. Centered Care focuses on what you want for yourself or a family member. This philosophy of care seems simple - ask the patient - but it is hard to deliver consistently and to understand invariably a patient’s wishes.
Physicians want to explain alternatives, but depending on the physician’s specialty there is always a bias to treat. If one sees an orthopedic surgeon, he or she may offer conservative measures, but surgery is almost always offered as well. And we now know that certain common procedures, such as arthroscopic knee surgery for chronic knee pain, may be no better than rest and physical therapy. Many medical and surgical societies have adopted a program called “Choosing Wisely” for common medical problems associated with their respective specialties. These expert advice programs expose many medical practices that have little or no value and are sometimes harmful. Examples include over prescribing antibiotics and ordering expensive imaging for problems such as acute low back pain which are usually self- limited and respond to conservative (or no) therapy.
However, a more serious issue for patient care and shared decision making occurs when the diagnosis is not only serious but emotionally charged, such as a diagnosis of cancer or heart disease. Patients should always consider a second or third opinion before starting treatment. Rarely does a short treatment delay affect an outcome and that delay often leads to better and more coordinated team-based care.
There are several points you should remember about cancer care in particular. Certain screenings, such as the PSA for prostate cancer, commonly overestimate the patient’s risk of progressive disease. Too frequent screenings for breast cancer may lead to false positive results and invasive additional painful testing. Patients with incurable metastatic cancer do better for a longer period of time when chemotherapy treatment is linked to palliative care. Cancer care is always better when it is team-based and truly patient-centered.
Please remember everything new is not always better. When your health is involved, ask yourself what you want as an acceptable outcome and experience. Advocate for yourself or have someone you trust advocate for you as your health care proxy.
Dr. Thomas Ebert has over 20 years of experience as a physician executive. Before joining Fallon Health, he served as the Chief Medical Officer at Health New England for 16 years. Dr. Ebert is board certified in Internal Medicine and Nephrology and a Fellow of the American College of Physicians. He practiced nephrology in Worcester for over 20 years.
This information provided by the Group Insurance Commission .