Dr. Niel Korsen (Guest): So in the old days, when doctors made all the decisions, what we found was that approaches to treatment vary, were different from one town to another. A great story is told by Jack Wennberg, who did much of the research that underlie shared decision making. He lived in a small town in Vermont and was less than a mile from the border with another town, and when he studied the rates at which kids had their tonsils out, the rate in one town was many times higher than in another, and yet the kids were probably essentially the same. So it was really the doctors’ opinion rather than the patients’ preferences that drove decision making. I think we understand now that in order to make a good decision, there need to be two experts in the room working together to make a decision. One is the clinician, who is an expert on what your condition is, what treatment options you have, and what the pros and cons are of each of those options. But to make a good decision, the other expert needs to be the patient with other family members, if they choose, who are experts on what’s important to the patient, what were the goals the patients had in coming to the doctor seeking treatment, and what are the important factors that will help them decide which option is best for them. We refer to those as preferences and values. You might hear that terminology.
Melanie: I think that’s so important that you brought up family members as well because, again, to be a good advocate -- and sometimes you need to bring that family member with you so they can hear what the doctor is saying as well so that it’s more ears trying to understand this complicated medical terminology and things. Now, what do you doctors think when a patient comes to you armed with information from the Internet or from others that they’ve heard about or talked to that have had the same condition? Do you warn against that? Do you like that? What do you think of it?
Dr. Korsen: I think that an informed patient is a better partner in making decisions. However, the information has to be accurate and up to date. I would much rather help a patient find sources of good information on the Internet than have them working on their own, because not everything, not all the information is good. Maine Medical Center is fortunate to have around the community a few learning resource centers where health educators can help patients find books or websites or other information that is up to date and reliably tells them about a health condition and its treatment. So, having information is a great thing as long as that information is accurate and up to date, and we can help you do that.
Melanie: Do you like it when a patient comes armed with a lot of questions and that they want to know a lot? Do you want them digging in to their own health care?
Dr. Korsen: Again, I would say that a patient who is interested and engaged is going to be, I would think, more satisfying to work with, and they’re also probably going to get better care. We do have time constraints during our appointments. We are working very hard to figure out how to use the whole team to make sure the patient gets the information they need, get their questions answered. I hope someday time constraints are less of an issue in health care. That’s where the tension would be if a patient has a 15-minute visit and has much more than 15 minutes worth of conversation to have. That’s where a patient might experience some pushback, and I think we all have to figure out how to do things differently to get beyond that.
Melanie: And what about if they ask you about a second opinion? And in this day and age of us trying to be our own best advocate, are doctors insulted by this, Dr. Korsen?
Dr. Korsen: Boy, I wouldn’t say I’m an expert on that, but I think especially when you’re considering a big procedure that has some risks involved, it makes good sense to get another opinion to help you make sure that you’ve considered all options. In some of the best examples of shared decision making within Maine Medical Center, the second opinion is actually something that’s part of the process. For example, when men are diagnosed with early stage prostate cancer, the Prostate Cancer Center makes sure that every man who wants to—and most now do want to—talks to a surgeon to hear what options are available surgically, talks to a radiation oncologist so they can understand what options are available in terms of radiation treatment so that they really understand all the options in front of them, the pros and cons, and with the help of a nurse who is referred to as a navigator, they make a well-informed decision, understanding all the options that are in front of them.
Melanie: What about questioning what your doctor has advised—“Do I really need this test or procedure?” What do you say to someone that is asking whether or not they do need whatever it is you’re recommending?
Dr. Korsen: I would welcome people asking those questions. Actually, I’m looking right now on my bulletin board at a list of five questions that have been recommended by an organization called Choosing Wisely. This is a partnership of Consumer Reports and the American Board of Internal Medicine, and through them, I think just about every specialty society representing any specialist you could imagine. And those five questions are: Do I really need to test or procedure? What are the risks? Are there simpler, safer options? What happens if I don’t do anything? And how much does it cost? I think we should expect our patients to ask questions of us. It’s much more, I would say, health care is more consumer-driven now than it was when I started practice 30 years ago, and I think those questions are important. And it should be okay for patients to make sure that they’re comfortable with the care that we’re recommending to them.
Melanie: In just the last minute, Dr. Korsen, if you would, your best advice about being your own best advocate and shared decision making with your clinician and why they should come to you at Maine Medical Center.
Dr. Korsen: I would start by saying that Maine Medical Center has wonderful doctors. I’ve been here, as I said, for more than 30 years, and the doctors there are well-intentioned and are doing their best to give you the best treatment possible. That being said, you are the person who knows what’s important to you, so I think the idea that the doctor explains to you what your condition is and what your treatment options are, you think about what’s important to you and what you’re trying to accomplished, and together you come to the best possible decision, I think that’s an approach that would be supported by my colleagues at Maine Medical Center. So I think it is worth your while to find out about reliable sources of health care information. The Maine Medical Center learning resource centers can help you do that. And then, armed with some information, go in to have an open discussion with the physician about what your options are, and think about what is the best match for what you’re trying to accomplish, what your goals are in seeking treatment.
Melanie: That’s great information, really great information. Being your own best advocate is so important. Thank you so much, Dr. Korsen. For more information, you can go to mainemedicalcenter.org. That’s mainemedicalcenter.org, mmc.org. You’re listening to MMC Radio. This is Melanie Cole. Thanks so much for listening.