Giving People the Power to Make Choices is a Tricky Proposition

Terri Bernacchi, PharmD, MBA
Health Advisory Professionals
England’s infamous health care system is always undergoing flux and scrutiny as leaders try to find new and better ways to save money, provide care, and meet expectations for quality and outcomes. The concept of “shared decision making” and patient empowerment is proving to be difficult there, too, however, as evidenced by a recent article published in the British Medical Journal. The British government has publicized its plans to introduce wider choice and shared decision making within the NHS, but they are finding that it may be challenging to implement based on several factors, some of them unforeseen.

For example, evidence suggests that while patients like the idea of a choice of physician and being involved in personal health decision making, the clinicians are not necessarily warm to the idea. Changing these attitudes in the provider community requires changing entrenched styles and operating beliefs within the professional community itself.

Moreover, while the UK National Health System already provides patients with information on quality, safety and outcomes and promises to publish more detailed information in the future, the evidence suggests the patients are not using it! And it appears that physicians don’t really understand what the patients themselves want regarding information and decision making.

While there are decision aids for many diseases and conditions already in place, the NHS and its practitioners continue to struggle with how to embed these tools, and how to shift attitudes and skills so that shared decision making will be put into more routine practice.

How can this information from the NHS help those of us in the United States, where the idea that a patient would not have choices is a foreign, even hostile concept? 2010's health care reform has been unpopular with a large percentage of Americans. But the reality that every individual’s inevitable need for health care looms in front of all of us and the lessons learned by the NHS are helpful. In order to create a fully empowered (and accountable) patient in the US, we need to make sure that:  

• the patient understands the information that should be considered in making decisions and the consequences of each option
• the physician and other supporting clinicians are encouraged to work with the empowered patient which may mean reforming paternalistic patterns of communication and care
• the financial system that is the underpinning for the empowered patient must support the process of “Shared Decision Making”, without creating disincentives to the physician, the patient, or other stakeholders like family members.

Read more: http://www.4ni.co.uk/northern_ireland_news.asp?id=117833

Terri currently works for a large health sciences firm serving payers, pharmaceutical and device manufacturers and other stakeholders in health care as a Senior Principal in Managed Markets. The thoughts put forth on these postings are not necessarily reflective of the views of her employer nor other Health Thought Leader colleagues. Terri has had a varied career in health related settings including: 9 years in a clinical hospital pharmacy setting, 3 years as a pharmaceutical sales rep serving government, wholesaler, managed markets and traditional physician sales, 3 years working for the executive team of an integrated health system working with physician practices, 4 years as the director of pharmacy for a large BCBS plan, 12 years experience as founder and primary servant of a health technology company which was sold to her current employer three years ago. She has both a BS and a PharmD in Pharmacy and an MBA.