Steve Atlas, one of our medical editors and a primary care provider at Massachusetts General Hospital, recently wrote a perspective piece in Spine that got me thinking about shared decision making as a way to strengthen the relationships between providers and patients.
Lumbar spinal fusion is a complex surgery that uses hardware and/or a patient’s own bone to fuse together two or more vertebrae in the lower spine. Spinal fusion is a useful treatment for certain back problems. But it’s often no better than non-surgical approaches or simpler surgeries for common conditions like sciatica caused by a herniated disc or spinal stenosis. And it has more risks than the alternatives, especially for older patients.
Despite practice guidelines aimed at encouraging appropriate use of fusion, rates remain high. In response, some insurers, including Blue Cross Blue Shield of North Carolina, have developed coverage policies in an effort to ensure appropriate use of the procedure.
Steve writes that coverage policies like these can make clinicians feel like they are being “second-guessed by a bureaucratic process.”
I’ll bet patients don’t like them, either.
What if patients had a chance to learn about the benefits and downsides of spinal fusion?
What if they knew that there was a good chance that a simpler, less invasive, and less risky approach could do just as well as spinal fusion at relieving their pain and other symptoms?
What if, instead of coverage policies that drive a bureaucratic wedge between patients and providers, patients had access to decision aids that outlined their options, made clear the benefits, harms, and tradeoffs of their options, and invited them to think about what outcomes matter most to them?
I’ll bet providers and patients would like that a whole lot better.
Steve agrees, “For many spine conditions, a shared decision making process involving an engaged patient and a doctor who is willing to discuss a range of treatment options could lead to patients being better informed about the risks, benefits, and alternatives. Compared to jumping through the hoops of a bureaucratic process—it seems like a no-brainer.”