Ashish Jha

Just a few years ago, things were looking up for the American health care system. We were going to start finding better ways to pay for care: call it pay-for-performance (P4P), value-based purchasing (VBP), or similar terms. We were going to nudge -- or, rather, push -- providers into more clinically integrated systems (e.g., ACOs) to help improve outcomes and to control costs. And, of course, with wider use of electronic health records (EHR), we'd be able to better coordinate care and make decisions based on actual data. It all sounded very promising. Now, though -- what's that old expression about the leopard not being able to change its spots?...

If you've ever had a hard time trying to decide what's best for your health (e.g., Sorry, There's Nothing Magical About Breakfast), perhaps you can take comfort in the fact that physicians often aren't so sure either. Or perhaps not. A new study in Annals of Surgery, and nicely reported on  by Julia Belluz in Vox, focused on surgical uncertainty.  The researchers sent four detailed clinical vignettes to a national sample of surgeons, seeking to get their assessment on the risks/benefits of operative and non-operative treatment, as well as their recommendations. You'd like to think there was good consensus on what to do, but that was not the case...