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Peter Beaulieu, MPH

Thank you for your post. Your description of the difficulty in delivering preference-sensitive care to our patients is spot on, and I agree that the decision making process used in this instance is not explained using the utility to the patient. Frequently, in the office I have patients who are either misinformed about the meaning of their lab/imaging results, or they have no understanding about the results at all. Using the utility to the patient to determine the most beneficial path relies on both parties having an understanding of what the utility is to the patient.

That is to say, a patient has to have a sense and the understanding to know what a slightly elevated PSA means to their health in the same way they would understand their choice to gamble for a 50% chance to win $100 or to gain $50 outright. Patients lack the ability to make that health care decision simply because they can't define the utility for themselves.

This leaves patient and provider in a difficult situation. One that will only be solved through extensive patient education and a commitment to transparency of successes and risks alike.

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