Dr. Sheldon Greenfield, whose pioneering research found that older patients with breast and pancreatic cancer got subpar treatment and that patients who grill their doctors during consultations receive better care, died on Feb. 26 at his home in Newport Beach, Calif. He was 86.
The cause was colon cancer, his daughter Lauren Greenfield said.
Dr. Greenfield was a founder and director of the Center for Health
Policy Research at the University of California, Irvine, and a leader of the Medical Outcomes Study, involving more than 22,000 patients and 500 physicians. It determined in 1986 that doctors often ordered exorbitant and unnecessary tests and referred patients to a specialist when a primary care doctor or a nurse practitioner could have delivered equally good care.
Alan M. Garber, the president of Harvard University, praised Dr. Greenfield as “a towering figure in health care research.”
“His influence extended more widely than even he could have known, through the Medical Outcomes Study and so much else,” Dr. Garber said in an email.
In 1991, Dr. Greenfield and collaborators including his wife, Dr. Sherrie Kaplan, found that too many conversations about care are dominated by doctors. They recommended a protocol that included a 20-minute coaching session for patients before they consulted their physicians.
“When doctors dominate the medical interview, patients don’t do as well as when the patient exerts more control,”
Diabetes patients who asked questions about dosage and volunteered other symptoms during checkups recorded a 15 percent drop in blood sugar after two months, according to a study in 1995. Similar results were found in studies of patients with ulcers and hypertension.
As that study’s principal author, Dr. Greenfield explained that the researchers focused on adult diabetes because of its prevalence and because the proper treatment can prevent complications that make it one of the most expensive chronic diseases to treat.
Four years earlier, a research team that Dr. Greenfield led had concluded that while 96 percent of women ages 50 to 69 with breast cancer received the appropriate minimal level of acceptable care, only 83 percent of otherwise healthy women 70 and older did. (The study defined “appropriate” as either removal of the entire breast and some surrounding tissue or removal of the lump and the nearest lymph node, followed by radiation treatment.)
