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Fast Food Medicine: A Missed Opportunity for Shared Decision Making


It was time for my yearly check-up, and I selected a family practice doctor in my neighborhood. I expected and wanted a drive thru type healthcare visit, quick and easy since I am healthy. The appointment went well. We mused over the day's health headlines, grumbled about some insurance reimbursement battles, and shared some personal interests. However, on my way out the door, I was handed a referral for an ultrasound of my neck for lymphadenopathy. I was confused since we, (the doctor and I), had not talked about this during the appointment.

When I asked about this unexpected referral, my doctor indicated that during my examination she had noted that I had enlarged lymph nodes in my neck and groin. I had no other symptoms or any suggestions of illness. I asked her if the test was really necessary, and she indicated, "Yes, you could have lymphoma."

Though I appreciate the thoroughness of my physical examination and, yes, a potential harmful diagnosis could be indicated by my slightly enlarged lymph nodes, I was taken aback by the whole experience. Why wasn't this discussed during the appointment if there was a real danger? Why use such a drastic term like lymphoma when other diagnoses were possible? Were my lymph nodes really swollen? It seems to me they were always this size.

I left the office and ended up calling people whose opinion I respected, put my referral in a folder, and let the whole thing blow over. In all the years of getting yearly physicals and being lucky with having good health, I never had any problems, complaints or abnormal findings in a physical exam. I chose not to have any further testing. But I remained disappointed. My doctor could have minimized the confusion, fear, and trepidation that an experience like this could cause.

How? She could have implemented shared decision making during the exam room rather than slipping me a piece of paper on my way out the door like a trick-or-treater on Halloween, leaving me with my own resources and Dr. Google, away from her expertise and guidance, to determine if further testing was necessary or not.

After this experience, considering research supporting shared decision making, and hearing about other people's health care experiences, we cannot underestimate the importance of including people in their health care decisions. We, as patients or potential patients, are also interested in lassoing and reigning in out of control health care costs. Higher insurance premiums come out of our weekly pay-checks and unnecessary medical tests cost us money, cause worry, lead to future overtreatment, or even harm.

We are the ones who are deciding whether or not go forward with our care and are able to tap on the brakes when we want. We are invested in our heath and want the opportunity to weigh the evidence with the skills and expertise of a clinician guiding our decision making. We don't want to be left at sea on our own 'make 'shift' rafts without the resources of our clinicians trying to decide what's next. Providing an opportunity and space for us to participate in our health care decisions can reduce and eliminate unnecessary tests that people don't want.

Though I may want 'fast food health care' when I'm healthy, I don't want it if I'm sick or have the potential to be sick. People want to have the opportunity for a dining-in experience, not just fast food.


More Blog Posts by Sarah Jorgenson

author bio

Sarah Jorgenson, MA, MS, is currently a medical student in Chicago. Previously, she served as a communications and research associate for the Center for Advancing Health (CFAH) and as a contributing writer for its Health Behavior News Service. She graduated with an MA in Bioethics, Humanities and Society from Michigan State University (MSU), where she worked as a research assistant for Dr. Margaret Holmes-Rovner with the Center for Ethics and Humanities in the Life Sciences. She served on the research team for CFAH's Snapshot of People's Engagement in Their Health Care, contributed to a Cochrane Review update, and participated in research on shared decision making for patients with coronary artery disease. She also worked as a receptionist at MSU's Child Health Care Clinic for two years and collaborated as part of the research team for its Patient Centered Medical Home. You can follow her on her blog and on Twitter via @SarahJorgenson.

Tags for this article:
Disease Screening   Get Preventive Health Care   Inside Healthcare   Patient Engagement   Sarah Jorgenson  

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