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Gaps in evidence drive movement toward shared decision-making

Shared decision making is of public interest - at least to anyone who thinks they might one day go to the doctor.

"This must be gratifying to Jack Wennberg," panel moderator Gary Schwitzer, publisher of HealthNewsReview.org, mused at the end of the question and answer session following the panelists' presentations.

"He couldn't get his work published for 30 years. He was laughed at, considered a pariah. Finally, he had to publish in Science, which is not exactly a standard journal for variations in health care." Using Medicare data, his Dartmouth Atlas of Health Care demonstrated striking variations in the kind of care patients receive - and the resulting costs - depending simply on where they live.

As it has been applied, Wennberg's pioneering research revealed a large number of medical procedures where there is no clinical consensus as to the course of treatment. In response, there is movement to educate - and mandate - physicians to include their patients in the decision-making process.

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