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Doctors Ignoring Guidelines

Posted by Sharon W on 6/25/03 at 17:04 (122939)

A recent study shows that primary care doctors very often are NOT providing patients with the care recommended by their professional associations' treatment guidelines. Check it out (excerpts below):





By JANET McCONNAUGHEY, Associated Press Writer

'Treatment guidelines, many written by medical specialty organizations, outline recommended approaches to many common ailments, ranging from painkillers and exercise for arthritis to surgery for breast cancer.'

'However, the guidelines are often ignored, indicating that even people who have good insurance and doctors they like don't always get the best care, said Elizabeth McGlynn, a researcher with the Rand Corp. think-tank who led a study published in Thursday's New England Journal of Medicine.'

'Her study documents a broad range of lapses in treating and preventing run-of-the-mill illnesses. For instance, patients studied did not receive one-third of the recommended immunizations, one-third of the standard medicines for heart disease or half of the recommended care for diabetes.'

'This study showed that there is substantial discrepancy between what we say doctors ought to be doing and what they are doing,' said Dr. Earl Steinberg, an adjunct professor at Johns Hopkins University and head of a company that develops computer programs for doctors.'

'He and the ACP's president, Dr. Munsey S. Wheby, said affordable electronic systems that help doctors keep track of the latest guidelines could play a big part in solving the problem. Such systems run into six figures, Martin said.'

'Wheby said most doctors want to do the right thing for their patients, but he added: 'It's a matter of time, a matter of effective systems of reminder, at times knowing the correct guideline or the correct procedure.'

Re: Correction

Sharon W on 6/25/03 at 17:10 (122940)

Mmm, re-reading it, they apparently are talking about a problem with ALL doctors...


Re: Doctors Ignoring Guidelines

BrianG on 6/25/03 at 21:24 (122954)

I thought this was a great article. If anything, It reinforces my belief that we the patients, should take more of an interest in our own treatment. Thanks to the Internet, this is much easier than it used to be.


Re: Doctors Ignoring Guidelines

Ed Davis, DPM on 6/25/03 at 22:06 (122961)


Considering the expanding base of medical knowledge 'generalists' or family doctors have the need to know about more and more areas and may know less about each area. Eventually they will know nothing about everything. Specialists need to know more and more about less and less. Eventually they will know everything about nothing. ;)

The 'managed care' concept insists thea the family doctor be, in effect, the 'manager' of care. A large number of patients really need direct access to specialists in their area of need though. Diabetics, for example, need direct access to their internists, podiatrist.


Re: Doctors Ignoring Guidelines

Kathy G on 6/26/03 at 08:38 (122980)

One of the nicest things my PCP can say to me is that something is out of his field of expertise and he is recommending I see a specialist. With the exception of going to a rheumatologist, he has always suggested that I see a specialist. I never have to ask him. And in the case of the Rheumy, it turns out that he was treating me appropriately and I probably didn't have to see a specialist at all.

My sister, on the other hand, lives in another state and has a different PCP. He waits forever before he suggests a specialist and then, it's always at her request.

I believe one of the major players in all this is the insurance companies. I think that they expect the PCP to treat everything and never send his patients to a specialist, thus cutting the insurance companies' costs. Sadly, many PCP'd do just what the industry wants them to do. If you're looking for a good doctor, look for one the insurance companies hate. Two to one, he's the one that goes to bat for the patient when the insurers say they can't see a specialist or don't need a specific drug.

Kind of a sad state of affairs, isn't it?

Re: Doctors Ignoring Guidelines

Sharon W on 6/26/03 at 09:31 (122985)

Dr. Ed,

Good point about specialists knowing more and more about less and less. I think that phenomenon affects patients just as adversely as the over-generalized family doctor with managed care patients whose insurance will not cover them being sent to specialists.

While on paper a doctor is usually still listed as belonging to a more general specialty ('neurologist,' for example, or 'endocrinologist'), many do sub-specilize into a more specific area (a neurologist might sub-specilize in testing, or in peripheral neuropathy; an endocrinologist might sub-specialize in thyroid disorders or diabetes). The sad effect of this is, the endocrinologist that you are sent to because your PCP wants you evaluated for hypo-thyroidism, may know relatively little about thyroid because he specializes in diabetes! (etc. etc. etc.)

Often, a little (patient) research will reveal the name of a sub-specialist who focuses on YOUR particular problem -- but unless you live in a very big city, that sub-specialist is likely to be a couple of hours away and, as far as your insurance is concerned, 'out of area'. In a situation like that, the insurance company is very unlikely to even authorize for you to SEE this specialist, since there are other endocrinologists available to you who are ON your provider list -- and even if they DO, your insurance will cover a much smaller portion of the cost!!!

Just my two cents about #%!! insurance companies, and what they do to 'promote' the 'best possible patient care...' ;)


Re: Doctors Ignoring Guidelines

Sharon W on 6/26/03 at 09:44 (122988)


I, too, have been happy with my PCP for that reason. She never hesitates to send any of us to a specialist, and if we REQUEST to be sent to a specialist, she isn't at all offended. She also doesn't hesitate to do appropriate lab tests... and she has, in the past, disputed my insurance company's refusal to pay for certain drugs that she had prescribed.

OCCASIONALLY, she will even do a bit of research on a patient's behalf...

Still, I figure about 95% of doctors DO care enough about whether or not they will get PAID, that they won't order, or have their lab perform, any tests or procedures that they know won't be covered by insurance.


Re: Doctors Ignoring Guidelines

marie on 6/26/03 at 17:55 (123016)

I am pretty fortunate to have the doctors I do. Aside from the one bad experience with a neurologist they have all taken their time and done a good job. I have been reccomending my Pod who by far is the best doc I've seen to all the teachers I work with.....we all just love him. I think the main thing I appreciate from a doctor is that they don't come in and hurry me up or look at their watch while I'm talking.

Those little things count.