Bioethics Blogs

Great (if Unrealistic) Expectations

Good ethics begins with good facts. Right decisions and truly informed consent require correct information — or, at the least, the best information we have — and accurate expectations. A review recently published in JAMA Internal Medicine online suggests that this most basic condition for making good decisions is, in many instances of medical decision-making, lacking.

The article reviews studies that evaluated patients’ expectations about the potential harms and potential benefits of various medical procedures, including screening tests, diagnostic tests, medications, and procedures. The results are perhaps not surprising: the majority of patients overestimated the benefits and underestimated the harms of a host of interventions, from mammograms to cholesterol-lowering medications to prenatal ultrasounds to coronary bypass surgery.

There are no doubt many reasons for this. One is that many health care providers themselves don’t understand the potential harms and benefits of the things they order. Another is our society’s technical orientation: the imperative to just do something about it, and the belief that doing something is always better than not doing anything. Advertising — from sources like direct-to-consumer drug advertising, pharmaceutical reps, specialty “centers” (such as cancer centers), companies that go around performing ultrasound screening for a myriad of ailments — is more often designed to obfuscate and create unreasonable desires and expectations than to clearly inform. Our current medical system often pays doctors based on “production” — cranking through as many patients as possible as quickly as possible — which does not lend itself well to taking the time to sit down and discuss whether the potential benefits of a test or procedure really outweigh the potential harms.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.