What if shared decision making costs more?

I’d like to read the articles in JAMA Internal Medicine about shared decision making, but am too cheap to pay for access. So I’ll rely on the LA Times article on the topic to make a brief comment.

Apparently patients who engage in shared decision making spend an extra quarter day in the hospital and have medical bills a few percent higher than other patients. Conclusion: shared decision making costs more money. It’s an interesting topic and the results are provocative, but at least based on what I’ve read so far I’m not really seeing the results as a big deal or even unexpected.

Patients who are engaged in their own care and assertive may well ask for extra tests or treatments that didn’t occur to their care team, but may not stop their physician from ordering something they had in mind to do already. If the assertive, involved patients are well informed –which they might be based on the survey’s findings that they have more education than average– then maybe their outcomes will be better and it will be worth the cost.

Or maybe the analysis needs to consider a longer time frame for cost than just the specific hospitalization. Maybe those who are engaged are also more likely to have a good discharge plan and to avoid readmission to the hospital for something that could have been dealt with the first time.

May 28, 2013

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