New president elected for the Foundation for Informed Medical Decision Making non-profit organization

Aug 26 2009

Foundation pioneered high-quality AV decision aids for patients

Michael J. Barry, MD, of Massachusetts General Hospital and Harvard Medical School, has been named the new president of the Foundation for Informed Medical Decision Making, the non-profit organization in Boston that has pioneered the creation and use of high quality audio-visual decision aids to enhance patient involvement in their own medical decisions. Barry will replace Floyd J. Fowler, Ph.D., who has served in that capacity for the past seven years.

"Michael Barry is the natural choice for this position at this time," said Fowler. "He has been part of the Foundation from its inception. He has the depth of clinical experience, political acumen and personal integrity necessary to continue the Foundation's mission in the next decade."

The former Chief of the General Medicine Unit at Massachusetts General Hospital, Barry takes the lead at a time when the Foundation's influence as a catalyst for keeping patient needs at the center of the health care debate is growing. In fact, the concept of "shared decision making" (between patients and clinicians) and the use of decision aids to facilitate that process -- espoused by the Foundation -- are woven into a several major bills before Congress this summer.*

While 25 million Americans have access to the decision aids through pilot research programs and their health insurance organization, there is still a great deal of work to be done, according to Fowler and Barry. "Our goal now is to make shared decision-making a standard part of medical practice," said Barry.

"This is a very exciting time for this issue, but challenges still exist," said Barry, citing two large-scale studies funded by the Foundation and completed this year that illustrate those challenges. One study of physicians found that, despite their stated belief in shared decision-making, most do not yet practice it and cite time and money as barriers. Another study of 3,000 patients found that most do not receive sufficient information from physicians to make decisions that take their lifestyle, preferences and values into account.

In 1989, Barry and Fowler were part of the group of researchers and physicians that developed the evidence that led the co-founders, John E. Wennberg, MD, of Dartmouth Medical School, and Albert G. Mulley, MD, of MGH, to create the Foundation. In fact, the four decided together that increasing patient involvement in medical decisions was the best way to address a disturbing pattern in American medicine -- unwarranted and unpredictable variations in the way physicians treated the same diseases in different parts of the country.

For the first 15 years, the Foundation focused entirely on developing decision support tools that synthesized the evidence and explained treatment choices with clinical experts and real patients who had experienced the condition. Since 1997, the Foundation has partnered with Health Dialog to develop a broad-scale distribution model using health coaches and developed an extensive research agenda to learn how best to support patients making medical decisions. During Fowler's presidency, the Foundation expanded its mission to include funding clinical demonstration sites, to learn how best to integrate patient decision aids into everyday medical practice. It also greatly expanded its outreach efforts to spread a more general appreciation of how little patients are involved in decisions about their health care and why patients would be better served if they were routinely informed and involved.

Barry, who is board certified in internal medicine, received his MD at the University of Connecticut School Of Medicine and did his residency at Strong Memorial Hospital in Rochester as well as a fellowship in general medicine at Harvard. He has focused much of his life's work on finding the right way to screen for and treat prostate disease and has served as the Foundation's medical editor for decision aids on these conditions. Barry has also had a long-standing commitment to improving the quality of primary health care.

Barry has created and overseen one of the original demonstration sites for shared decision-making at MGH. That pilot program, which is integrated into the primary care practices at the hospital, prescribes decision aids on a variety of medical conditions as part of a patient's treatment plan. The prescription is entered into the medical record and the decision aid is picked up by or sent to the patient, much like a prescription for a medication.

According to one patient named Don, "I needed multiple opinions, but I also didn't have a lot of time to explore that. And so I think the video for me gave me that experience of getting multiple opinions without necessarily meeting with several doctors. It just gave me a lot more knowledge as I progressed in the treatment to feel like I was doing the right thing."