Why One-Size-Fits-All-Medicine Doesn’t Work

April 6, 2012
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“If we know what those best practices are, then I’m confident that doctors are going to want to engage in best practices. But I’m also confident patients are going to insist on it.… In some cases, people just don’t know what the best practices are.”

– President Barack Obama interview with Diane Sawyer, ABC News, June 2009.

“If we know what those best practices are, then I’m confident that doctors are going to want to engage in best practices. But I’m also confident patients are going to insist on it.… In some cases, people just don’t know what the best practices are.”

– President Barack Obama interview with Diane Sawyer, ABC News, June 2009.

But every patient does not, in fact, react in the same way to expert opinion. Nor does every doctor. More below the fold.

Over the past four years, we have interviewed scores of patients around the country about how they make medical decisions. We found “maximalists” who want to do everything possible and “minimalists” who are convinced that less is more; “believers” who are certain that a good solution exists for their illness and “doubters” who worry that almost any treatment will be worse than the disease. They developed these mind-sets largely based on past experience with illness, and they use them as a starting point for weighing risks and benefits in their health care.

Experts also have these distinct mind-sets, both as individuals and as groups. The federal Preventive Services Task Force, for one, embodies a minimalist, doubter mind-set. That is why experts can look at the same data and still disagree about what is best.

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The authors, Drs. Pamela Hartzband and Jerome Groopman from the faculty of the Harvard Medical School and the Beth Israel Deaconess Medical Center in Boston, don’t think this is a problem. I don’t either. What’s your view?