Health and Healthcare Audiences

Below, I list several speaking topics that I have enjoyed presenting to many medical audiences. In addition, I am happy to adapt any of the topics I list for general audiences and business audiences.

Critical Decisions: The challenge of shared decision making between physicians and patients

In 1974, Betty Ford went to sleep so that her doctors could biopsy a lump they had seen on her mammogram. She woke up in a hospital room with a huge bandage over her chest. They hadn’t removed a tiny lump. They’d removed her entire breast, without bothering to discuss the pros and cons of this treatment with her.

Medical practice has changed since the time of Betty Ford’s cancer treatment.  Physicians no longer make a habit of withholding cancer diagnoses from patients.  Indeed, many physicians now recognize that figuring out what is best for any given patients depends on discovering that patient’s individual preferences.

However, the patient empowerment movement has created a major dilemma in medical decision-making. Despite growing agreement that doctors and patients need to “work together,” too often neither doctors nor patients know how to negotiate this new relationship.

In this talk, I describe how hidden dynamics in the doctor/patient relationship keep us from making the best medical choices.  I describe the unconscious psychological forces that cause both doctors and patients to make decisions they would otherwise not make.  And I lay out a strategy, of research and practice, that holds the promise of improving the way we all make health care choices.

Does medicine need a dose of free market discipline?

In 1999, if you wanted to rid yourself of eyeglasses, you would be forced to fork over $2,100 to your ophthalmologist, so she could zap your eyes into shape. By 2005, that same laser procedure would cost you less than $1,700, and if you wanted a newer, improved laser procedure, you’d still be able to get it for that same 1999 price of $2,100.

Wall Street Journal editorialists point to such laser surgery as an example of what would happen if people were more accountable for their healthcare expenses, if medical care relied more on the free market.

In this talk, I show why this view is wrong, exploring why health care is particularly poorly suited to operate like a free market. Even in less demanding consumer domains, people’s purchasing decisions are often distorted by powerful psychological biases. In healthcare, these distortions are even more severe, contributing to rapidly escalating health care costs and price-insensitive decision making.

The price of life and the costs of hi-tech treatments

In the last decade, exciting new treatments have emerged that offer new hope for many people with previously incurable diseases.  New drugs to treat metastatic cancer.  New proton beam machines designed to destroy unhealthy tissue.  Hi-tech robots that assist surgeons in the most delicate of operations. But many of these interventions come at a staggering cost.  Some new chemotherapies cost more than $100,000 per patient. This leaves physicians in a dilemma: which patients should they offer these therapies to, and how should they go about discussing the cost of these therapies to patients who may not even be able to afford the copayments?

In this talk, I discuss the moral dilemmas caused by expensive new interventions and the psychological  forces that prevent us from making rational decisions about how to best make use of these promising technologies.