By Evan Falchuk

A fascinating study in the BMJ (paywalled – free version here) talks about a kind of misdiagnosis that isn’t widely recognized – failing to figure out exactly what it is the patient wants.  According to the authors, doctors too often guess at (or don’t think about) what the patient would want if they were as confident and well-informed as the doctor.  For example, one study found that doctors believe that 71% of patients with breast cancer rate keeping their breast as a top priority — while patients report that this is their top priority only 7% of the time.

It’s an important issue, and not just because we should want every patient to get the care most appropriate for them.  Research shows that as patients become better informed about their condition, they make different, and sometimes less costly, treatment choices.  A Canadian study found a reduction of heart surgery of more than 20% in patients who became more informed about their illness.

There is an important role for policymakers in building awareness among patients and doctors of this problem, and what to do about it.  Patients need to take an active, engaged role in their healthcare, and doctors need to recognize how important this is to the quality of care they deliver. Errors in diagnosing a patient’s preference

…lead to inaccurate assessments of wants and needs….Evidence from trials shows that engaged patients consume less healthcare. More work is needed to understand the magnitude of this potential benefit, but it is tantalising to consider that budget challenged health systems around the world could simultaneously give patients what they want and cut costs.

Indeed.