Health Affairs has published the results of focus groups, interviews and a survey of consumers to ascertain their views about evidence-based medicine. (Health Affairs Article) Evidence-based medicine has as a fundamental tenet that for most medical care there is an objective best treatment option, or at least a limited range of options from which to choose, for a patient’s particular need. For evidence-based medicine to be successful, both patients and physicians must be aware of the evidence, understand and consider it carefully, and discuss and use it in making a treatment decision.
Assuming that there are credible research findings which clearly identify the best option for a patient, the biggest problem with implementing evidence-based medicine would seem to be getting patients and physicians to use it. The Health Affairs research suggests that will not be easy for many consumers. The research looked at attitudes of consumers aged 18-64 who had employment-based health insurance. They did not have great receptivity to the core concepts of evidence-based medicine. In general, the respondents were not familiar with the basic terminology of evidence-based medicine.
The respondents tended to assume that all medical care met minimum quality standards, that medical guidelines were a sort of lowest-c0mm0n-denominator approach to medicine, that more care was better, that newer forms of treatment were better and that more costly care was better. In addition, many had not engaged in behaviors related to discussing treatment options with their physician and were often afraid to do so, for fear of offending the doctor or causing a negative reaction. On the positive side, most of the respondents appeared to agree with some of the key principals of value-based insurance design, a related concept. They thought people using doctors with higher quality ratings should pay less for insurance and care, as should people who participate in wellness programs or who use treatments shown to work best for their condition.
All-in-all, the research suggests a high hill to climb to reach the nirvana of the informed and engaged consumer; one who probably would have an attitude of “healthy” skepticism toward a physician’s recommendations. One useful extension of this research would be to examine willingness to engage in evidence-based medicine in relation to consumers’ health status. Those who have more disease and spending are most in need of the benefits of a more rational approach to treatment.