Doctor's Orders is a feature in the collaboration between MedPage Today and ABC News. In this monthly segment, we explore medical issues of interest to physicians and patients alike. This month, we look at the difficulties physicians face in incorporating evidenced-based medicine into their practice.
With the amount of research being published in medical journals and presented at meetings, it should not be surprising when a new finding slips by a busy physician.
Nor should it be surprising, then, that some decisions about patient care might be made without benefit of the most recent evidence.
Although experts interviewed by MedPage Today agreed that keeping up with the most current information is challenging, it's unclear exactly how widespread the phenomenon of the outdated doctor is.
"To some degree or another, I think it's very widespread," said Richard Deyo, MD, a professor of evidence-based family medicine at Oregon Health & Science University in Portland.
But he added that it's not a black-and-white issue, because physicians can be up to date in one area and lagging behind in another.
"I think we all are sort of somewhere along a continuum," he said.
Lori Heim, MD, president of the American Academy of Family Physicians, agreed that it's difficult to put a solid number on how many doctors are practicing outdated medicine.
She said a good place to start would be with the numerous studies that have found that many patients do not receive recommended care for various conditions.
One such study, released in the New England Journal of Medicine in 2003, reviewed the care received by surveyed adults in the two years preceding a telephone interview. A review of their medical records found that only 54.9 percent of the time did they get the care recommended for their condition.
However, Heim said, one can't conclude from that data that the other 45.1 percent of the care was delivered by doctors who were not up to date on the most recent evidence.
Perhaps, for instance, a diabetic patient was scheduled to come in for hemoglobin A1c screening but missed the appointment. That might have been listed as a failure to get the recommended care, said Heim, a hospitalist at Scotland Memorial Hospital in Laurinburg, N.C.
Board certification might provide another clue to whether a physician is keeping up to date, Heim said, although doctors who are not board certified might be keeping track of the latest findings and recommendations on their own.
Regardless of how prevalent the phenomenon of outdated doctors is, experts agree that time constraints are a major reason clinicians have difficulty keeping up with the constant flow of new medical information.
Although reading all of the relevant journals would keep a doctor updated, "it's unrealistic to expect the majority of physicians to go back to the original literature or even to go back to systematic reviews of the original literature," said Gordon Guyatt, MD, of McMaster University in Hamilton, Ontario, who is credited with coining the term "evidence-based medicine."
He said that aside from lack of time, training might explain some of the problem as well.
Most physicians practicing today were not trained in an era of evidence-based practice, Guyatt said, and thus, they didn't learn the skills necessary to keep updated or learn the best sources to reference.