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, which 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,” Dr. Greenfield told The New York Times that year.
Diabetes patients who asked questions about dosage and volunteered other symptoms during checkups, according to a study in 1995, recorded a 15 percent drop in blood sugar after two months. 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 it is prevalent 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.)
“The lives of these patients may be needlessly shortened,” Dr. Greenfield said.
In 1989, a group led by Dr. Greenfield found that older men who develop cancer of the prostate are less likely than younger men to receive the best available treatment.
He also expressed concern about the lack of appropriate follow-up care for cancer patients. He attributed this in part to the fact that, in many cases, insurance companies, health plans and Medicare don’t cover the necessary tests and examinations.
“Successful cancer care doesn’t end when patients walk out the door after completion of their initial treatments,” Dr. Greenfield told The Times.
The work he and Dr. Kaplan did “addressed the effects of the doctor-patient relationship on the outcomes of chronic illness,” Dr. Harold C. Sox, an emeritus professor at the Geisel School of Medicine at Dartmouth College, said in an email. “They showed that better doctor-patient partnerships paid off in better patient outcomes.”
“We hear a lot about the shortage of primary-care physicians,” Dr. Sox added. “Dr. Greenfield’s work showed that good primary care matters a lot.”
In another study, conducted in 1995, Dr. Greenfield found that treatment by health maintenance organizations and by doctors in traditional medical practices produced similar results, even though the H.M.O.s cost substantially less.
And in a report commissioned by the Food and Drug Administration after several well-publicized recalls of equipment that injured thousands of patients, Dr. Greenfield proposed a tougher approval process, which was, in part, adopted for a wide range of medical devices, including hip implants and external heart defibrillators.
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, Dr. Kaplan said, her husband “was heavily influenced by his own pediatrician, who was extremely kind and treated children with respect and care.”
After graduating from Harvard College with a bachelor’s degree in biochemistry in 1960, he earned a medical degree from the University of Cincinnati in 1964. From 1966 to 1968, he served in the Navy as a lieutenant commander, dealing with epidemic intelligence at the National Communicable Disease Center (now the Centers for Disease Control and Prevention).
He was an intern at Boston City Hospital and chief resident from 1971 to 1972 at Beth Israel Hospital (now Beth Israel Deaconess Medical Center), also in Boston.
In 1972, he moved to the University of California, Los Angeles, where he met Dr. Kaplan, was mentored by Dr. Charles E. Lewis and joined Dr. Lewis’s team, which applied algorithms to medical conditions to measure the quality of care.
He and Dr. Kaplan continued their work on the Medical Outcomes Study at Tufts University School of Medicine, where they founded the Primary Care Outcomes Research Institute.
He taught at U.C.L.A., Tufts and the Harvard School of Public Health before moving in 2003 from Boston to Southern California, where he and Dr. Kaplan established the Health Policy Research Institute at Irvine.
In addition to Dr. Kaplan, whom he married in 1983, and his daughter Lauren, from his marriage to Patricia Marks, which ended in divorce, Dr. Greenfield is survived by a son, Matthew Greenfield, also from that marriage; two children, Rob Greenfield and Wendi Morner, from his marriage to Dr. Kaplan; eight grandchildren; and a sister, Joanne Zappin.
In the 1970s and ’80s, Dr. Greenfield volunteered at the Venice Family Clinic in Venice, Calif., where he lived. He had become acutely aware of the lack of local and affordable medical care when his family’s babysitter became ill and he had to drive her to the closest public hospital, in Torrance, nearly 40 miles away.
“It made an indelible impression on me,” Dr. Greenfield said in an interview on the clinic’s website, “about how difficult it was, not in the abstract but as a practical matter, for people to get medical care when they needed it.”
