When doctors fail to stay up-to-date, patients suffer serious consequences

docshistoric-300x234Doctors put their patients at grave risk by failing to stay current with professional best practices, eliminating outdated and ineffective therapies and approaches and instead learning and adapting better ways of care, notably treatments to help deal with the opioid crisis.

Vulnerable children can pay an unacceptable price, for example, for pediatricians’ unwillingness to “unlearn” what they were taught decades earlier in medical school, reported Aaron Carrol, a professor of pediatrics at Indiana University School of Medicine, a health researcher, and a contributor to the New York Times’ evidence-based column “The Upshot.” As he wrote:

In May, a systematic review in JAMA Pediatrics looked at the medical literature related to overuse in pediatric care published in 2016. The articles were ranked by the quality of methods; the magnitude of potential harm to patients from overuse; and the potential number of children that might be harmed. In 2016 alone, studies were published that showed that we still recommend that children consume commercial rehydration drinks (like Pedialyte), which cost more, when their drink of choice would do. We give antidepressants to children too often. We induce deliveries too early, instead of waiting for labor to kick in naturally, which is associated with developmental issues in children born that way. We get X-rays of ankles looking for injuries we almost never find. And although there’s almost no evidence that hydrolyzed formulas do anything to prevent allergic or autoimmune disease, they’re still recommended in many guidelines.

Carroll looks at a practice, once recommended, “to keep patients in the intensive care unit in a tight range of blood glucose levels. The evidence base for these recommendations came from observational studies that showed that patients with such tight control seemed less likely to develop adverse outcomes like infections or hyperglycemia, and they seemed more likely to survive.” Subsequent, more rigorous research debunked “tight glycemic control,” and urged doctors to stop using it.

They haven’t. Doctors also seem oblivious to high-powered, best-intentioned groups — often with blue-chip colleagues in their number — that do the hard work of scrutinizing the flood of medical-scientific studies and clinical evidence to offer best advice on various treatments, Carroll says, noting:

Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, is entirely focused on the identification of care that physicians routinely recommend but shouldn’t. Almost 600 different tests, procedures or treatments, collected over the last six years, are currently listed on their website. Almost all the recommendations basically say ‘don’t do’ them. This overuse doesn’t provide a benefit. It can lead to harms. It can also cost a lot of money.

Separately, Elisabeth Rosenthal  a — nonpracticing doctor and high profile medical journalist (formerly of the New York Times and now the leader of the independent, nonprofit Kaiser Health News Service)  —reported in a Fortune online opinion piece about how tough it can be to get doctors to change course once they dig in, especially with cancer care. Current research shows that too many women undergo harsh, extended chemotherapy for early-stage breast cancer when it’s unnecessary, she reminds. She underscores that doctors put women through needless discomfort if not downright suffering because they don’t practice evidence-based medicine.

Lagging on addiction treatment

Meantime, as the nation confronts a drug abuse  epidemic that has become the leading killer of Americans 50 and younger, doctors are “ill equipped” to provide medical assistance, with medical schools notably devoid of attempts to educate practitioners about a raging problem in healthcare, the New York Times reported in a separate story. As Jan Hoffman wrote:

According to the Centers for Disease Control and Prevention, addiction — whether to tobaccoalcohol or other drugs — is a disease that contributes to 632,000 deaths in the United States annually. But comprehensive addiction training is rare in American medical education. A report by the National Center on Addiction and Substance Abuse at Columbia University called out “the failure of the medical profession at every level — in medical school, residency training, continuing education and in practice” to adequately address addiction. Dr. Timothy Brennan, who directs an addiction medicine fellowship at Mount Sinai Health System, said that combating the crisis with this provider work force is ‘like trying to fight World War II with only the Coast Guard.’

A handful of institutions nationwide have stepped up to prepare physicians to better treat addictions, substance abuse, and overdoses, Hoffman reported, focusing on the doctors and students at Boston University and Boston Medical Center. The news report shows that treating addicted and drug-abusing patients can be as complex and challenging as any other medical specialty, and aspiring doctors find the work rewarding and satisfying, especially if they overcome the stigmatization of drug users and abusers.

Although the need for medical treatment and addiction specialists may be dire, support for educating doctors in this area is spare, Hoffman wrote:

There are only 52 addiction medicine fellowships (addiction psychiatry is a separate discipline), minuscule compared to other subspecialties. In August, the first dozen finally received gold-standard board certification status from the Accreditation Council for Graduate Medical Education (by contrast, there are at least 235 accredited programs in sports medicine). While most medical schools now offer some education about opioids, only about 15 of 180 American programs teach addiction as including alcohol, tobacco and other drugs, according to Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, which presses for professionalization of the subspecialty. And the content in all schools varies, he noted, ranging from one pharmacology lecture to several weeks during a third-year clinical rotation, usually in psychiatry or family medicine. Programs rarely go deeper.

In my practice, I see the harms that patients suffer while seeking medical services and their struggles to access and afford safe, efficient, and even excellent medical care — including their need to partner with their physicians to ensure MDs stay up to date. My firm and I represent clients whose babies and children have suffered unacceptable medical harms, including by receiving dangerous drugs. It’s unfathomable, as Carroll reported, that so many youngsters still get prescribed powerful drugs, such as antipsychotics, when medical standards and common sense argue against their use.

It’s also puzzling and frustrating to know that medical students lack deeper training in addictions and substance abuse, when, swayed by Big Pharma and its corruptive practices, medical faculty may commonly “pimp” aspiring doctors, grilling them mercilessly about prescription drugs and their uses in care. Why can’t this purported rigor be applied to imparting lifesaving knowledge about opioids?

Yes, doctors may be asked to try to keep up with best practices in their field, even as there’s an explosion under way in just medical publishing. But modern medicine — and patients especially — would benefit greatly if doctors, for example, shut their ears more and used their proven brain firepower to resist what has become proven, lethal Big Pharma hype about drugs, especially opioids.

And, at a time when profit-maximizing medical practices allow doctors to spend just 13 to 16 minutes on average with each patient, wouldn’t it be a point of professional pride and responsibility for physicians to know they were giving the best, state-of-the-art treatment? Physicians have lots of treating to do of themselves and their profession, so we patients don’t suffer harms.

Photo credit: Central Dispensary and Emergency Hospital, Washington, D.C., House Staff and Auto-Ambulance. National Library of Medicine.
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