"Medicine is still practiced
like it was 90 or 100 years ago," says the author of a recent study, which
found many doctors don't routinely use computers to send medical reminders
— for mammograms or blood tests — nor do they take advantage of
other programs that track patients between visits.
According to the author, Dr.
Lawrence Casalino, assistant professor, health studies, University of Chicago.
"Medical care traditionally has been what your individual doctor can do in
10 to 15 minutes when you happen to show up at his or her office. If you don't
come in, nothing happens."
Doctors on average have adopted
only five of 16 recommended "care management" approaches. One in six
doctors doesn't use any of the programs, which include compiling lists of
patients with similar diseases, educating the sick to help themselves and
offering ways for patients to grade their medical care.
Researchers at the University of
Chicago and University of California at Berkeley interviewed top officials at
1,040 medical groups and independent practice associations from 2000-2001. The
groups act as intermediaries between insurance companies and doctors.
The officials described how their
doctors take care of patients with four chronic diseases — asthma,
congestive heart failure, depression and diabetes. The findings of the survey
appear in the Jan. 22 issue of the Journal of the American Medical Association.
According to the survey, 70
percent of doctors don't keep registries of patients with chronic diseases.
"If a medical group doesn't know who their diabetics are, it's hard to
know if they're getting their blood sugar checked at appropriate intervals and
getting flu shots," Casalino says.
Casalino acknowledges doctors are
making progress, but he still finds it "a little odd" that
veterinarians track patients better between appointments than doctors.
Why are doctors not adopting the
recommended programs touted in federal reports? "There's a certain lack of
awareness because these things aren't well known yet, and a lot of physicians
are skeptical…," Casalino says.
The medical profession is also
slower than most industries in its adoption of medical technology, he adds,
pointing out that many doctors still give drug orders by hand, potentially
causing more errors than by computer ordering.
"The industry is behind, but
doctors' offices are especially behind," he says. "They have the
least capital to invest and the fewest managers around to make these things
In California, change is coming
courtesy of a coalition of insurance companies, medical groups, doctors,
patients and others. The group, known as the Integrated Healthcare Association,
is adopting a system that will provide extra funds for medical groups that adopt
recommended approaches to taking care of patients, says executive director Beau
One problem is the current system
doesn't reward groups of doctors "for being the best," Carter says.
"We've got our work cut out for us."
Source Material: "Most Doctors Behind the Times," by Randy Dotinga, from
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