When it comes to health care, we have embraced a story that, by promising the delivery of high-value care, has become as easy to believe as it is to tell. The value framework for physicians means being held accountable for patient outcomes and resource consumption, whereas patients are reminded that value simply means getting what matters to them. By fostering divergent foci for our attention, this narrative allows us to continue ignoring the tough choices facing our health care system.Read the whole thing.
If we want to simultaneously improve quality and cut costs, we must first stop creating incentives that effectively split patients and physicians onto different teams. We must acknowledge that shared decision making is just that: shared. We must admit that turning health care into a customer-service industry may to some extent undermine the delivery of evidence-based care. And we must admit how little we actually know about patients' values and about how they should or might influence our decision making, the delivery of evidence-based care, rising costs, and patient outcomes.