My comment: The Amreican physician – patient interaction is complex. It is apparent to me that many in policy positions don’t understand simple aspects of care that will have huge implications as the ACA is adopted and ACOs become more prevalent.

It is MUCH harder and more time consuming for a physician to counsel a patient NOT to have a procedure than it is to persuade a patient to havee a procedure.  Many pundits have estimated there will be a glut of physicians as procedures are ratcheted down with greater adoption of appropriate use guideleines and evidence based medicine.  Unfortunately this will not be the case.  American patients generally are suspicious when physicians counsel against evaluation or treatment.  And this is occurring in the current fee for service environment.  We are in for a significant transitional storm for the next several years as physicians become incentivized (in ACOs) to limit care.

This JAMA essay speaks about physician adoption of new guidelines, but says litle about paiteints willingness to limit care.

See on jama.jamanetwork.com