Influence?? What Influence?

Physicians are not all that independent

Several items of importance were in the news this week. One that caught our eye related to the use of "guidelines" in medical practice. Treatment of urinary tract infections was the focus.

There are groups of concerned physicians who have developed guidelines for several areas of medical practice. Their purpose is to present providers with models of patient management recommended by acknowledged experts in various fields. Part of the rationale for this is that we are seeing more and more physician "extenders" who are less well trained than medical school graduates.

Nonetheless, most of this activity is directed at doctors who may have developed poor practice traits for whatever reason (too busy, too long out of school, etc). Unfortunately, most physicians resent the idea that they might need to be guided through something they have been doing for years. Perhaps "insulted" is a better description than "resentful". Thus, "practice guidelines" may not be used by those who need them the most. In this case, guidelines for treatment of urinary tract infections are being ignored.

First line therapy of uncomplicated urinary infections (by far the most common) should be with drugs which are historically effective and not expensive, such as sulfa combinations and amoxicillin. What is happening is that providers are using these agents less and less, relying instead on newer drugs, such as the very expensive (and, it must be said, very effective) Cipro family. The main reason for this behavior, we are disappointed to admit, remains and forever will be (apparently) the influence of pharmaceutical companies. Their attractive representatives, elaborate advertising, and nifty little enticements are too much for practitioners to resist.

So much for your guidelines!

Here's another item, too good to pass up. The University of Arizona just got a nice grant to study the genetics of asthma victims. The lead researchers expect to be able to develop an anti-asthma vaccine from the information they'll get. Good luck to them in their pursuit of this form of therapy. At the moment, it seems like a big undertaking. How would you immunize someone against their own reaction to agents which are difficult to identify?

On returnig to one's roots:

To the best of our recollection, it was Sinclair Lewis who wrote about a newly minted physician coming back to his rural hometown to establish a practice. This idealized version of the young doctor returning to his "root" area has not been seen frequently in real life for the last thirty years. For a lot of reasons, very few recent graduates opt for a rural situation. It's hard work, the pay isn't the best, and getting coverage for "off time" takes lots of persuasion and luck. Specialist help is often far, far away, resulting in tremors and bad headaches for the young family practitioner.

So why would anyone want to take on a small town practice?
Lots of us have done it, and we are going to line up a few to tell you their stories - why they left the cities, and how it turned out. We'll let you know when this happens. It will be in our "Guest" section.