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Carla C. Keirns, MD, MA, MS, PhD; Susan Dorr Goold, MD, MHSA, MA

JAMA. 2009;302(16):1805-1806.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Over the past 20 years or so, there has been a rise of 2 parallel movements, one toward the explicit use of clinical trial data to guide clinical practice (evidence-based medicine) and the other toward patient empowerment through explicit informed consent, shared decision making, and patient-centered care. Both components have been integrated into models of quality clinical care, but sometimes there are conflicts between evidence- and guideline-driven care and patient-centered care.

In most situations, patients value prevention of disease and disability and increased length of life, so patient-centered care and application of evidence-based medicine present no conflict. Despite general preferences for health over disease, however, individuals make trade-offs every day by working in dangerous or stressful jobs, driving too fast, eating too much, smoking, and taking dozens of other risks, large and small. These everyday compromises are . . . [Full Text of this Article]

Guideline-Directed Care and Pay for Performance

Author Affiliations: Robert Wood Johnson Clinical Scholars Program, University of Michigan School of Medicine, Ann Arbor (Drs Keirns and Goold); Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor (Drs Keirns and Goold); Bioethics Program, University of Michigan, Ann Arbor (Drs Keirns and Goold); VA Health Services Research and Development Center of Excellence and Department of Ambulatory Care, Ann Arbor VA Health System (Dr Keirns); and Center for Medical Humanities, Compassionate Care, and Bioethics, Departments of Preventive Medicine and Department of Medicine, Stony Brook University, Stony Brook, New York (Dr Keirns).

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