Dr. Sheldon Greenfield, whose pioneering research has discovered that older patients with the breast and pancreas cancer received poor treatment and that patients grilling their doctors during consultations receive better treatments, died on February 26 at his house in Newport Beach, California. He was 86 years old.
The cause was colon cancer, said her daughter Lauren Greenfield.
Dr. Greenfield was founder and director of the Center for Health Policy Research at the University of California, Irvine, and leader of the study on medical results, which involved over 22,000 patients and 500 doctors. In 1986 he established that doctors often ordered exorbitant and unnecessary tests and directed patients to a specialist when a general practitioner or a nurse could have provided equally good care.
Alan M. Garber, president of the University of Harvard, praised Dr. Greenfield as “an imposing figure in the research on health care”.
“His influence extended more widely than he could have known, through the study of medical results and so much more,” said dr. Garber in one and -mail.
In 1991, Dr. Greenfield and collaborators including his wife, Dr. Sherrie Kaplan, found that too many conversations on care are dominated by doctors. They recommended a protocol that included a 20 -minute coaching session for patients before consulting their doctors.
“When doctors dominate the medical interview, patients do not do it as when the patient exercises greater control,” said dr. Greenfield at the New York Times that year.
Patients with diabetes who asked questions about the dosage and other symptoms were offered during the checks recorded a 15 % drop in blood sugar after two months, according to a 1995 study. Similar results were found in studies on patients with ulcers and hypertension.
As the main author of that study, Dr. Greenfield explained that the researchers have focused on adult diabetes due to its prevalence and because adequate treatment can prevent complications that make it one of the more expensive chronic diseases to be treated.
Four years earlier, a research team that Dr. Greenfield had concluded that, while 96 % of women aged between 50 and 69 with breast cancer received the minimum level of acceptable care, only 83 % of otherwise healthy and more women. (The study defined “appropriate” as a removal of the entire breast and some surrounding fabrics or removal of the nodulus and the nearest lymph node, followed by a treatment with radiation.)
“The life of these patients can be unnecessarily reduced,” said dr. Greenfield.
In 1989, a group led by Dr. Greenfield discovered that the oldest men who develop prostate cancer are less likely than younger men to receive the best available treatment.
He also expressed concern about the lack of adequate follow-up assistance for cancer patients. It has attributed it in part to the fact that, in many cases, insurance companies, health plans and medicating do not cover the necessary tests and exams.
“The care of successful cancer does not end when patients leave the door after completing their initial treatments,” said dr. Greenfield at the Times.
The work that he and Dr. Kaplan have “faced the effects of the medical-patient relationship on the results of the chronic disease,” Dr. said in an e-mail. Harold C. Sox, emeritus professor at the Geisel School of Medicine of the Dartmouth College. “They have shown that a better partnership as a doctor-patient has made its fruits to the best patient results.”
“We feel a lot about the lack of primary assistance doctors,” added dr. SOX. “Dr. Greenfield’s work has shown that the good primary treatments are very important. “
In another study, conducted in 1995, Dr. Greenfield discovered that the treatment by health maintenance and doctors organizations in traditional medical practices has produced similar results, even if HMOS costs substantially less.
And in a report commissioned by the Food and Drug Administration after several well -advertised calls of equipment that have wounded thousands of patients, Dr. Greenfield proposed a harder approval process. It was adopted, in part, for a wide range of medical devices, including hip plants and the defibrillators of the external heart.
Sheldon Greenfield was born on April 22, 1938 in Cincinnati. His father, Robert, owned a clothing store. His mother, Faye (Bloch) Greenfield, taught Sunday school.
In deciding to pursue a career in medicine, said dr. Kaplan, her husband “was strongly influenced by her own pediatrician, who was extremely kind and treated children with respect and care”.
After graduating from Harvard College with a biochemistry degree in 1960, he graduated in Medicine from the University of Cincinnati. From 1966 to 1968, he served in the Navy as a commander of the Lieutenant, facing epidemic intelligence at the National Communicable disease Center (now the Center for Disease Control and Prevention).
He was an intern at the Boston City Hospital and his head residing from 1971 to 1972 at the Beth Israel hospital (now Beth Israel Deaconess Medical Center), also in Boston.
In 1972, he moved to the University of California, in Los Angeles, where he met Dr. Kaplan, was led by Dr. Charles E. Lewis and joined the Dr. Lewis team, who applied algorithms to medical conditions to measure the quality of the treatments.
He and Dr. Kaplan continued their work on the study of medical results at the Tufts University School of Medicine, where they founded the research institute on basic results.
Dr. Greenfield taught the UCLA, Tufts and Harvard School of Public Health before moving from Boston to Southern California in 2003, where he and Dr. Kaplan established the Health Policy Research Institute in Irvine.
In addition to dr. Kaplan, who married in 1983, and his daughter Lauren, from his wedding to Patricia Marks, who ended with divorce, Dr. Greenfield survived a son, Matthew Greenfield, even from that wedding; Two children, Rob Greenfield and Wendi Morner, from his wedding to Dr. Kaplan; eight grandchildren; And a sister, Joanne Zappin.
In the 70s and 80s, Dr. Greenfield took volunteer at the Venice family clinic of Venice, California, where he lived. He had become deeply aware of the lack of local and convenient medical care when his family’s babysitter fell ill and had to take her to the nearest public hospital, in Torrance, almost 40 miles away.
“It made me an indelible impression for me,” said dr. Greenfield in an interview on the clinic website, “on how difficult it was, not in abstract but as a practical question, for people get medical care when they needed it.”