The Current Response
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The Current Response

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THE CONSENSUS ON WHAT IS NEEDED

The consensus on the problem of clinical decision making which was recently crystalised in the WIM report is also mirrored in the report’s recommendations

Following are three of the ten recommendations of the WIM report.

  • The patient as the source of control. Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. The health system should ... and encourage shared decision-making.
  • Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
  • Evidence-based decision-making. Patients should receive care based on the best available scientific knowledge. Care should not vary illogically from clinician to clinician or from place to place.
The WIM report also proposed that within 5 years standardized treatments for the 15 most important diseases should be developed. What the report failed to do of course was to say how the above obviously worthy objectives be translated into practice except that it urged Congress to devote 1 billion dollars over this period to research in the area.

Again Donald Berwick, president and chief executive officer of the Institute for Healthcare Improvement and Chair of the National Advisory Council of the Agency for Healthcare Research and Quality in a June 1999 interview with "Managed Care"said:

  • I think it's a design principle for the 21st-century practice that patients make the decisions, that the practice exists to give people information, on the basis of which, they make choices about their care. That concept is somewhat present in health care today, but it's a fundamental principle for practices of the future. Another one might be use of technologies to get people to the medical literature fast so that they can benefit from the evidence instead of having to search around too hard.
  • ... providing immediate, universal access to information (for doctors) and ensuring that our patients would always benefit from the best available scientific evidence
  • First, the work of medical care will shift from the provision of a personal service to the provision of information as its core process.
  • Control over care decisions will shift dramatically from professionals to patients and their families.
  • Care choices, made collegially by patients and clinicians, will rely on facts and knowledge more than ever.