Getting Doctors to Listen: Ethics and Outcomes Data in Context

Getting Doctors to Listen: Ethics and Outcomes Data in Context

Getting Doctors to Listen: Ethics and Outcomes Data in Context

Getting Doctors to Listen: Ethics and Outcomes Data in Context


This book examines why physicians are often surprisingly reluctant to follow guidelines for treating patients based on research data. It assesses the merits of these concerns -- which include worries about legal liability, financial incentives, the scientific validity of the data, and the objectivity of the issuer of the guidelines. It also proposes ways of developing more useful data and more effective guidelines that would reduce physicians' objections.


The story told in this book emerged from Dan Callahan's hunch that a significant trend within health care—the implementation of outcomes data and practice guidelines—might simply stall from resistance to the data by its physician‐ users. Careful listening to physicians indicated that they provide many moral sounding reasons (e.g., "My patient understood the recommendations but wants some other intervention") for setting aside recommendations that were associated with outcomes data and practice guidelines. Dan hypothesized that this moral resistance could undercut the outcomes movement; alternatively, if the moral resistance was identified and addressed, then this could improve acceptance of outcomes data. The Agency for Health Care Policy and Research (AHCPR) of the National Institutes of Health concurred that this hypothesis needed to be explored, so it funded a two-year study at The Hastings Center. Terry Shannon of AHCPR was particularly instrumental in providing direction and support for carrying out the project.

The attempt to identify and understand the moral reasons given by physicians resistant to using outcomes data required the participation of dozens of physicians from four sites around the country. Not all of the countless individuals can be thanked here for the hours they donated by participating in focus groups and research meetings. The project members who have contributed to this volume are visible; however, other project members who nurtured these ideas require special thanks. Foremost, the advice of Sandy Tanenbaum was seminal for thinking through the ideas articulated in this book.

In addition to Dan Callahan, other colleagues at the Center provided important critique and support for teasing out the medical details and philosophical issues, including, Joe Fins, MD, Jim and Hilde Nelson, Bette Crigger and Bruce Jennings. Moreover several projects members made the focus groups possible at the sites, most especially Wilmer Rutt, MD, Jane Gerety, Susan Hill; MD, Jeff Brensilver, MD, and Douglas Owens, MD.

Other participants who contributed to the project include: Renée Anspach, Marianne Baird, Eric J. Cassell, MD, Alan R. Fleischman, MD, Cornelia Fleming, Thomas Glenn, MD, Sidney Goldstein, MD, Hank Greely, Ichiro Kawachi, MD, Elizabeth Lane, MD, Nathan Levin, MD, Michael Massanari . . .

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