Shared Decision Making
I know of no safe depository of the ultimate power of the society but the people
themselves; and if we think them not enlightened enough to exercise their control
with a wholesome discretion, the remedy is not to take it from them, but to inform
their discretion. —Thomas Jefferson1
CONSUMERS HAVE a critically important role in helping to restrain the use of ineffective, marginal, or harmful new medical treatments. They create the demand for new treatments, and they ultimately pay for those treatments. They deserve their money's worth for these treatments, and their health may depend on them. Consumers have become more wary and more knowledgeable about many consumer products, like cars and stereos. But they typically have little experience on which to base their judgments about new medical technology. In an unfamiliar arena, they often have to trust expert advice.
And yet, as we've seen, medical technology includes some lemons, just like the car lots do. And sometimes even experts have sold lemons. Consumers may have faced buying a car or a house dozens of times, and gotten smarter about it each time. But when they are faced with a decision about treatment for breast cancer, whether or not to have back surgery, or which treatment is best for coronary heart disease, they're likely to be facing the decision for the first time, and the stakes are high.