Food and Health Rethought

Doctors disagree with each other up to 50% of the time, and are often out of date - get a 2nd opinion!

The data below underscores how often doctors fail. It really indicates that if you have any type of serious ailment and any doubts about your doctor’s recommendations, a second opinion is critical. Doctors should be required to better keep up with the latest medical evidence and should be required to take tougher annual tests to ensure they are indeed up to date with reality.

The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process—from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment. Physician judgment is highly variable. 

Here is what Eddy has found in his research. Give a group of cardiologists high-quality coronary angiograms (a type of radiograph or x-ray) of typical patients and they will disagree about the diagnosis for about half of the patients. They will disagree with themselves on two successive readings of the same angiograms up to one-third of the time. Ask a group of experts to estimate the effect of colon-cancer screening on colon-cancer mortality and answers will range from five percent to 95 percent. 

Ask fifty cardiovascular surgeons to estimate the probabilities of various risks associated with xenografts (animal-tissue transplant) versus mechanical heart valves and you’ll get answers to the same question ranging from zero percent to about 50 percent. (Ask about the 10-year probability of valve failure with xenografts and you’ll get a range of three percent to 95 percent.) 

Give surgeons a written description of a surgical problem, and half of the group will recommend surgery, while the other half will not. Survey them again two years later and as many as 40 percent of the same surgeons will disagree with their previous opinions and change their recommendations. Research studies back up all of these findings, according to Eddy.

On average, Americans only receive about half of recommended medical care for common illnesses, according to research led by Elizabeth McGlynn, PhD, director of Rand’s Center for Research on Quality in Health Care. That means the average American receives care that fails to meet professional evidence-based standards about half of the time.

McGlynn and her colleagues examined thousands of patient medical records from around the country for physician performance on 439 indicators of quality of care for thirty acute and chronic conditions as well as preventive care, making the Rand study one of the largest of its kind ever undertaken.

Even though clinical guidelines exist for practices like these, McGlynn and her colleagues found something shocking: physicians get it right about 55 percent of the time across all medical conditions. In other words, patients receive recommended care only about 55 percent of the time, on average. It doesn’t matter whether that care is acute (to treat current illnesses), chronic (to treat and manage conditions that cause recurring illnesses, like diabetes and asthma) or preventive (to avert acute episodes like heart attack and stroke).

How well physicians did for any particular condition varied substantially, ranging from about 79 percent of recommended care delivered for early-stage cataracts to about 11 percent of recommended care for alcohol dependence. Physicians prescribe the recommended medication about 69 percent of the time, follow appropriate lab-testing recommendations about 62 percent of the time and follow appropriate surgical guidelines 57 percent of the time. Physicians adhere to recommended care guidelines 23 percent of the time for hip fracture, 25 percent of the time for atrial fibrillation, 39 percent for community-acquired pneumonia, 41 percent for urinary-tract infection and 45 percent for diabetes mellitus. 

Underuse of recommended services was actually more common than overuse: about 46 percent of patients did not receive recommended care, while about 11 percent of participants received care that was not recommended and was potentially harmful. 

Here is disturbing proof that physicians often fail to follow solid scientific evidence of what “quality care” is in providing common care that any of us might need:

• Only one-quarter of diabetes patients received essential blood-sugar tests. 
• Patients with hypertension failed to receive one-third the recommended care. 
• Coronary-artery-disease patients received only about two-thirds of the recommended care. 
• Just under two-thirds of eligible heart-attack patients received aspirin, which is proven to reduce the risk of death and stroke. 
• Only about two-thirds of elderly patients had received or been offered a pneumococcal vaccine (to help prevent them from developing pneumonia). 
• Scarcely more than one-third of eligible patients had been screened for colorectal cancer. 

Here’s a counterintuitive consequence: the more years of practice experience a physician has, the more out-of-date his or her practice patterns may be.

Many doctors are incompetent, or at the very least have recommended things to me or my family which were simply wrong - or disagreed with the opinions of better doctors who were subsequently proved to be correct. This article validates that feeling I have with data, so it’s nice on some level to see that… On the other hand, some doctors, are brilliant wonderful geniuses, so it’s important to know which sort of doctor you are dealing with, and even then, it’s important to be careful.

via twilightfades