More Road Maps

These are non-political, we assure you

According to a survey reported in a recent issue of the New England Journal of Medicine, physicians in this country are doing a lousy job of following the rule-book.

For several years, it has been common in medical circles of influence to gather groups of experts in one or another of many fields of practice and pick their brains about the proper way to do things. These panels study a disease or condition carefully and completely, then issue "guidelines" to assist and direct the daily practice of our doctors. Use of the guidelines by an individual physician is not enforced by any agency, professional or governmental, resulting in rather haphazard application thereof.

Guidelines for management of diabetes, for example, include such things as consultations with ophthalmologists and podiatrists at regular intervals, a regular test to determine adequacy of sugar control over the last month, a visit with a dietitian at intervals, evaluation of kidney and heart status, etc. There are some others on this list for proper management of diabetic patients according to the panel of experts.

The NEJM article reports that for most situations where guidelines have been published, physician compliance with them is abysmal. In some cases studied, well under half of the patient records examined showed that providers were up to speed in applying the very simple and straightforward guidelines. Why is this?

Old habits are hard to break. (Doctors in practice for more than a few years establish their own guidelines and they are comfortable within them. If their patients seem happy with their care, and aren't regularly getting into tons of trouble, why change?)

"Don't tell me what to do! I got out of medical school and residency with just as much knowledge as the so-called 'experts'!" (Alas, this is too often the case. Physicians, never known as ego deficient, don't really like to be told what they're doing isn't adequate, making it easy for them to ignore advice.)

"Do you have any IDEA how much time it would take for me to institute all of that stuff into my practice? Everyone in this office is already working at top speed.! And I don't usually finish up the day until 9PM!" (Hmm. That is a problem, isn't it? How do we pile a bigger load on the very ones carrying the most as it is?)

"There isn't room enough in a gymnasium to file all of the paperwork." (True enough. Every consultation report, every lab test and xray report, has its own little space in the world of filing, adding up to a very large amount of space occupied.)

In response, we could point to practices which manage to use good medical principles, treat their patients well and completely, and still finish the day at 5PM. (Don't ask for a list of these right now, OK?) It's done through a combination of efficiency, proper assignment of tasks to supporting personnel, using the most skilled staff for the most difficult jobs, and using wellness or focus groups to manage several patients with similar diagnoses at the same time.

It sounds as though we're proposing an entirely new concept of healthcare delivery - innovative, comprehensive, efficient, user friendly, AND employing guidelines whenever available. Indeed, that is what we are proposing. It's called a Healthcare Cooperative, it's on the drawing board now, and anyone interested can find out more by contacting us.