Giving Patients a Larger Voice

Georgetown's Taylor has conducted several studies that found that men who received decision aids walked away with a better understanding of the PSA test, regardless of whether they chose to be tested.

Who Has Time?

Only a handful of hospitals have made shared decision-making a standard of care.

Encouraged by Wennberg, Dartmouth-Hitchcock Medical Center, in Hanover, N.H., in 1999 became one of the first in the country to set aside funds for shared decision-making. The hospital now offers 30 decision aids for such surgeries as mastectomy and lumpectomy, prostatectomy and back surgery.

The researchers want Medicare to support research needed to design balanced, effective aids for patients and to determine when to make them available. Getting shared decision-making incorporated into hospitals and doctors' offices will come, its advocates suggest, when Medicare and other payers begin reimbursing doctors and hospitals for using it.

In the meantime, patients can let their doctors know whether they want to play a more active role in their medical care. Kuba says part of the reason she has stuck with the Fairfax Family Practice for 20 years is the ability to discuss every treatment and test with her doctor.

"There's always a give and take," she says. "They help me put it all together." ¿

Shannon Brownlee is the author of "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer" (Bloomsbury). Comments:health@washpost.com.