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Have You SEEN Your Options? Patients Should Make Safe, Effective, Economical, Necessary Choices


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A recent conversation with my friend Jane, a well-educated professional, was not an unusual one:

Jane: "My surgeon says he has to go into the shoulder joint and clean out some kind of thick goo that has developed there. He says it's the only thing that will help me. I'm scheduled for week after next."

Me: "Oh, that sounds serious! Who's the surgeon?"

Jane: "Oh, he's the guy who did my husband's knee and my friend's shoulder. Everybody loves him."

Me: "Have you thought about a second opinion or some physical therapy?"

Jane: "The surgeon says PT won't help me. And I really trust him."

Me: "OK. Any idea about the safety of the hospital facility he uses?"

Jane: "Oh, that's right; you do work in health care, don't you? What do you mean?"

Me: "You know, things like infections or errors, operating on the wrong arm – that sort of thing."

Jane: "No. Where would I find that? Plus, my surgeon only uses this clinic."

Me: "OK, any estimate of how much it will cost?"

Jane: "Doesn't insurance decide that?"

And so on...

Jane is quite a perfectionist, at least usually. I was almost certain that if she was having work done on her kitchen, she would be getting competitive bids, asking for references and looking up the vendor on the Better Business Bureau. But not for her shoulder.

This seems to be the state of consumerism in health care. Despite a significant transition toward high-deductible plans, broader availability of (some) price and quality information, and efforts by many large employers to provide decision tools, consumerism is not the norm. Our surveys show only incremental adoption of behaviors such as asking about price or looking up quality information.

I do empathize. It's still not easy to be an active consumer when it comes to health. Plus, being a conscientious health care consumer has become yet another seemingly insurmountable endeavor similar to other big challenges. Will getting a hybrid car have any impact on global warming? Will a pledge to never buy ivory save the world's elephants? Will one less dose of antibiotics prevent future drug-resistant infections? Will my vote actually stop the standoff in Congress? It feels futile, unless a lot of other people do it too.

Plus, big, complicated, or inconspicuous issues are hard to incorporate into everyday life. We know they are important, but we don't actually see the ozone layer, methicillin-resistant Staphylococcus aureus, or the behind-the-scenes lobbying in the state capital. What can we do?

Faced with out-of-control spending and frighteningly common medical errors, it's no wonder so many of us tune out the noise. How do I know if the doctor and nurse are washing their hands? So my magnetic resonance imaging costs $1,000 instead of $400? I don't even know whether insurance will pay for that. How can saving $600 matter when we spend an astronomical $3 trillion on health care nationally every year?

The fact that it is so huge just makes it less tangible to the average person. We have trouble dedicating attention to it, even though we know it is a true threat. Turns out, comparisons between U.S. health care and climate change come with similar dire warnings (that we can't do anything about):

  • About health care spending: At the current pace, by 2022, "health spending is projected to be 19.9 percent of GDP" and grow to $5 trillion, meaning $1 for health care and $4 for everything else: education, social services, defense... [1]
  • About heath care safety: "New estimates now suggest that 400,000 people in the U.S. die each year from preventable errors in hospitals, four times more frequently than estimated earlier." [2]
  • About global warming last week: Without significant mitigation: "By 2100, temperatures could be about 6.7 degrees warmer... The huge sheet of ice over Greenland could melt entirely, leading to as much as a 23-foot rise in world ocean levels, leaving many coastal cities underwater." [3]

With health care, as with global climate change, many of us throw in the towel. What difference will it make if one person shops around? If she finds a procedure with a slightly lower price or a surgeon who might follow evidence-based guidelines, what could that do except cost her time and energy?

For consumerism to make noticeable steps forward, there does need to be a better way to personalize the benefits of being involved in one's care as well as the risks of not being involved. My friend Jane is a smart, accomplished woman whose life experiences have never included questioning (or even discussing) a physician's advice or considering that one hospital may be safer or less expensive than another. How will we normalize these activities for people like Jane?

A simple message: Don't decide until you've SEEN your options.

Perhaps we need a concise mantra for what it means to be a consumer. It could be as simple as asking ourselves whether we have compared and SEEN our options. Make sure you understand your options and have compared the degree to which they are Safe, Effective, Economical and Necessary.

In other words, do you know how your service/facility compares to others in safety, whether the service has been shown to be as effective as other options if not more so, whether the price is economical compared to others offering the service and whether a treatment or test is considered medically necessary?

If we ask ourselves before seeking any medical service, "Have I SEEN my options?," it might prompt us to look for the important information before we go and to ask for more information when we're there. If we can't find the information, we can't confirm that the option is the best one for our situation.

Like efforts to improve our environmental and political climates, changes in health care will happen both at the policy and individual levels. It will take the same people who vote, recycle and use public transportation understanding what's at stake for things to change.

Postscript: I saw Jane two weeks later and asked when surgery was scheduled. She said that three days before the surgical appointment, her shoulder (that could "only be fixed with surgery") had suddenly improved and she decided not to have the procedure. I was relieved, because she had not SEEN anything about the treatment she was scheduled to receive.

[1] Centers for Medicare and Medicaid Services. (2013). National health expenditure projections 2012-2022.

[2] James, J. T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122–128.

[3] Rice, D. (2014). Science group says climate change worsening, dangerous. USA Today.

This post originally appeared on Altarum's blog on September 23, 2014.

More Blog Posts by Wendy Lynch

author bio

Wendy Lynch, Ph.D., is the Director for Altarum Institute's Center for Consumer Choice in Health Care. Dr. Lynch also runs her own consulting firm and serves as senior scientist at the Health as Human Capital Foundation, which is focused on education and research about economic incentives in health care. Dr. Lynch is a frequent speaker and author, including her book, “Aligning Incentives, Information and Choice.” This piece was originally published on Altarum's Health Policy Forum blog, where Dr. Lynch is a regular contributor. You can find Altarum on Twitter at @Altarum.

Tags for this article:
Patient Engagement   Evidence-Based Medicine   Make Good Treatment Decisions   Women's Health   Inside Healthcare   Medical/Hospital Practice  

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