The Importance of Current Clinical Knowledge for Doctors

In both hospitals and primary care practice one of the biggest dangers for patients comes from the “failure to treat” syndrome (a term I apply to failed encounters with the medical establishment from a lack of communication, hurried times in examinations, and myriad other causes including lack of knowledge on the part of the physician). When the doctor’s lack of knowledge on a specific area is involved, there is a good chance this comes from lack of current clinical information. An article in the British Medical Journal (BMJ, October 26 1996 (313:26) by Richard Smith highlighted the dangers 17 years ago. Numerous other studies have focused on this topic, before and since Smith’s report, without significant visible results. Smith noted that, “About a third of doctors’ time is spent recording and synthesizing information, and a third of the costs of a hospital are spent on personal and professional communication. Yet most of the information doctors use when seeing patients they keep in their heads in what has been called ‘a ‘constantly expanding and reinterpreted database.’”
Smith continued, saying, “Unfortunately, some of the information in doctors’ heads is out of date and wrong, new information may not have penetrated, and the information may not be there to deal with patients with uncommon problems.”
When Smith wrote this, biomedical information was estimated to be doubling every 19 years, or, putting it another way, during a physician’s lifetime, there is a four-fold increase in medical knowledge. Now, the doubling time of medical knowledge is almost certainly shorter. In Up To Date, an online White Paper from Wolters Kluwer, by Denise S. Basow, MD, several of the chapter headings alone are enough to outline the problems:
Quality of Care Declines as Physicians Are Further Out of Training
Traditional Forms of Continuing Medical Education Are Ineffective
Too Many Clinical Questions Go Unanswered.
The magnitude of the problem, taken from Basow’s White Paper is this:
“The problem is getting worse. Only 39 randomized controlled trials (considered to be the gold-standard for clinical trial design) were published in 1965 compared with more than 26,000 in 2008 [3].This represents an approximate doubling every ten years, suggesting that there will be more than 50,000 randomized controlled trials published annually by 2019.”
Basow says, “Optimal medical care requires that clinicians apply the best available evidence to clinical decision making. Thus, the inability to keep up with evolving medical knowledge has potentially serious implications on quality of care.” Simply put, there is too much medical information and not enough time for practicing physicians and their staff to keep up with developments
One way to see this issue in concrete terms is to look at a hypothetical (but probably all too real) example. Given past experience, this case well could occur even at a major urban medical clinic where you might hope everyone was up to speed. You contact the doctor’s office because symptoms suggest that you are developing the flu and you are concerned because of your age. You have read about some drugs that, if given within the first 48 hours can shorten the duration of the flu and perhaps prevent more serious consequences. However, you find that the doctor’s nurse is unaware of the use of Influenza Antiviral drugs recommended by the Centers for Disease Control. The nurse has not heard of the Rapid Influenza Diagnostic Tests (RIDTs) either. Not only is the office staff unaware of these drugs or the test, but they are quite sure that, “the doctor does not use anything like that!” What do you do?
As a patient you have two choices: a) Act as a low-information patient, accept what you hear and hope for the best; or B) Do some online research at sources like the Mayo Clinic, eMedicine, or PubMed from the National Library of Medicine. Learn more about the particular issue at hand. Then, depending on your relationship with your doctor (in other words, will he/she accept questions from patients) either take your information to your doctor or find another doctor who has kept up with developments and will listen to you.
The answer seems simple—at least if you want to have a fair shot at surviving in an increasingly dangerous world. Each person owes a duty to themselves and their loved ones to be diligent about seeking answers, using the full power of reputable web sites, for whatever health issue is involved. Because of the problems staying up to date, do not accept at face value anything a health care professional tells you without verifying it in other reliable sources. Remember the statistics: The second or third leading cause of death and disability in the U.S. is the American Health Care Establishment. And if you think it is bad now, just wait a few years for the full impact of ObamaCare!
Remember the motto of this blog: Your health is too important to leave to the medical establishment.