This timely guide to communication in patient-centered medicine argues for greater clarity in explaining health risks versus benefits of an array of screening tests, procedures, and drug regimens. It reviews the growing trend toward patients' involvement in their own care, particularly in terms of chronic conditions, and details approaches physicians can use to prepare patients (and themselves) for collaborative decision-making based on informed choices and clear, meaningful knowledge. Chapters apply this lens to a wide range of common interventions as contentious as estrogen replacement therapy and antibiotics, and as widely prescribed as the daily aspirin and the annual physical. With this goal in mind, the authors also introduce an innovative decision-making tool that translates risks and benefits into a clear graphic format for fewer chances of miscommunication or misunderstanding.
Among the topics covered:
- Involving the patient in decision making.
- Towards a universal decision aid.
- BRCT: the Benefit/Risk Characterization Theater.
- Breast Cancer Screening-Mammograms.
- Prostate Cancer Screening.
- Colon cancer screening with colonoscopy.
- Screening for and treating dementia.
- Statins, cholesterol, and coronary heart disease.
Physicians in family and internal medicine will find Interpreting Health Benefits and Risks: A Practical Guide to Facilitate Doctor- Patient Communication a valuable resource for communicating with patients and new possibilities for working toward their better health and health education.
This book considers several common and important situations where faulty decision-making makes overtreatment a serious risk. Clear, fair, referenced, and useful information is provided. And a powerful intuitive technique is introduced which allows patient and doctor to talk as equals as they work together in the exam room. The authors emphasize that some patients who have been fully educated will still accept high risks of harm for a small chance of avoiding premature death. But as this book is accepted and its ideas and technique are extended, I feel sure that net harm to patients will be curtailed. And what is more, the integrity of the decision-making process will be improved.
-Thomas Finucane, MD, Professor of Medicine, Division of Gerontology and Geriatric Medicine, The Johns Hopkins University School of Medicine
Erik Rifkin is the president of an environmental consulting firm that specializes in the characterization of ecological and human health risks from exposure to soil, water, air and sediments. His firm provides assistance and guidance to federal and state regulatory agencies and corporations regarding the nature and magnitude of environmental risks and potential remediation strategies. Dr. Rifkin's broad experience includes the communication of health risks and benefits to groups concerned with these issues.
Part I: Setting the Stage.- Shared Decision Making (SDM).- Decision Aids.- Towards a Universal Decision Aid.- Involving the Patient in Decision Making.- BRCTs.- Part II: Case Studies - Health Benefits and Risks.- Breast Cancer Screening: Mammograms.- Colon Cancer Screening with Colonoscopy.- Prostate Cancer Screening.- Screening for Lung Cancer with Spiral CT.- Health Effects of Smoking.- Exercise Stress Tests.- The Use of Warfarin in Atrial Fibrillation.- Aspirin for Prevention of Heart Disease and Stroke.- Screening for Carotid Disease in Asymptomatic Patients.- Cholesterol Screening.- Statins, Cholesterol and Coronary Heart Disease.- Annual Exam.- Screening for and Treating Dementia.- Osteoporosis: Bone Density Testing and Drug Treatment.- Osteoporosis: Calcium and Vitamin D.- Estrogen Replacement Therapy.- Vitamins and Supplements.- MRI and Back Pain.- Antibiotics in Sinusitis and Bronchitis.- Final Thoughts.