Of course consumers don't understand evidence-based medicine


The esteemed policy journal Health Affairs last week ran results of a new study from the Department of Obvious Results--er, I mean the California HealthCare Foundation. The study, entitled, "Evidence That Consumers Are Skeptical about Evidence-Based Health Care," found that consumers generally believe that new care and more care are almost always better.

"The idea that getting high-quality care or the 'right' care could mean getting less care was counterintuitive. As one interview participant said, 'I don't see how extra care can be harmful to your health. Care would only benefit you,'" the research team reports.

The study also found that consumers tend to believe that all care meets some sort of minimum quality standards and that their own providers simply were too competent to deliver substandard care. Consumers further expressed a belief that medical guidelines don't allow much leeway for physicians to deviate from. "As one participant said, 'Using medical guidelines sounds like...your doctor can't give you other treatment without approval. It's taking your choice away and putting the decision in somebody else's hands,'" the report says.

As for evidence-based medicine, well, what kind of medicine do you mean?

"Participants had crucial misconceptions about the underlying concepts of evidence-based healthcare," the researchers write. "They found terms such as 'medical evidence,' 'quality guidelines,' and 'quality standards' unfamiliar and confusing. This lack of familiarity with key concepts was consistent with a finding from our national online survey that only half of the respondents had read or heard about 'medical research studies [that] help doctors know what works best for patient care.'"

Well, duh. Doesn't conventional wisdom hold that insurance that covers everything is synonymous with quality care?

Remember the recent debate on so-called "comprehensive healthcare reform," when many people clamored for the same kind of "Cadillac plans" that members of Congress enjoy? They wanted access to "quality care" via insurance that required few out-of-pocket expenses. Sorry, but having good insurance doesn't guarantee anything beyond someone else picking up the tab.

I'd advise you to ask the late Rep. John Murtha (D-Pa.), but, alas, you can't. He's dead, despite having a "Cadillac" insurance plan.

Murtha, you will recall, died in February at the age of 77 of "complications from to gallbladder surgery," otherwise known as a hospital-acquired infection. Although Murtha supposedly had great insurance, he likely was the victim of a preventable medical error.

This story really got glossed over because, well, see the results of the above survey. If people can't distinguish "new" and "expensive" from "quality," how will they ever understand concepts like evidence-based medicine or clinical decision support? I mean, why would highly educated doctors ever need a computer to help them reach decisions? Medicine is as much art as science, right?

And you wonder why there's so little focus on quality of care in reforming America's broken health system.

On another note, I've gotten word from Australia that John Glass, co-founding director of consulting and publishing firm CHIK Services, is on leave as he undergoes treatment for acute leukemia. He regularly makes the long trip to the States for the annual HIMSS conference, so you may have met him, too. Best of luck for a speedy recovery, John. - Neil

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