A biased survey about public perception of treatment guidelines prompted me to write my first ever letter to Health Affairs, which has just been published. (It’s a subscription only journal so you might not be able to view it.)
I was surprised by the article, which indicated that the public found arguments against treatment guidelines (such as “doctors will be unable to tailor care to needs of individual patients”) a lot more compelling than the arguments in favor (such as “doctors have economic incentives to provide inappropriate care.”) Something seemed wrong, but I had to delve into the technical appendix –available only online– to figure out what the problem was. I’m sure at least 95 percent of readers didn’t do that, which is why I decided to write my letter. I’m in favor of research based treatment guidelines, but after reading how the authors prefaced the question I think I would have also agreed with the “con” arguments. Here’s the wording:
Some people have proposed establishing an outside group to develop national treatment guidelines based on the latest scientific evidence. Doctors would be required to follow these guidelines when they treat patients. The government and insurance companies would refuse to pay for any treatments not supported by the guidelines even if a doctor thinks this treatment is best for their patient.
The researchers themselves included the emphasis on the words “even if a doctor thinks this treatment is best for their patient.” Instead, I think the researchers should have replaced the italicized words with, “unless a physician documents why this treatment is best for their patient.” Payers do tend to base payments on adherence to guidelines, but there is generally a lot more wiggle room than the authors imply. The authors’ wording certainly explains why people would be convinced that doctors would not be able to tailor treatment!
For more details, see my initial post on the topic (Public is skeptical of treatment guidelines –or are they?).December 9, 2010