Thursday Quickies: Patient "engagement" plus cost

First, I got in to a Twitter discussion today with patient engagement advocate Dave deBronkart about his article that criticized this study.  The study was being advertised under the headline "When doctors and patients share in decision making, hospital costs go up".  The issue is the headline implies that the study looked at what happened when patients and doctors made decisions together.  In reality, the study asked admitted patients if they felt they should make decisions with the doctor, not whether or not they actually did.  It turns out that the costs for the individual hospital stay was about $860 higher for those who wanted to collaborate (median cost was $14,000 to begin with).  None of this was tied to outcome or future costs, so we have no idea if this was $800 that saved money in the long run, or $800 wasted.  It's pretty insidious, because it's being used to justify a rather paternalistic model of medicine that many people (including Dave) have been working hard to get away from.