Thursday, April 23, 2015
Why Many Doctors Don't Follow 'Best Practices'
Brown says some doctors don't know the latest guidelines, which is somewhat understandable, since there can be hundreds to follow.
But often, he says, doctors order extra tests because they think someone down the line — another surgeon or anesthesiologist — will require them.
Sequencing the genes of a cancer cell turns up lots of genetic mutations — but some of them are harmless. The goal is to figure out which mutations are the troublemakers.
"[It becomes] this game of tag," he says, "where you're doing something because you think somebody else wants it, even if you don't really want it."
So, even in the midst of good science and a clear consensus on what should be done, a lot of physicians don't follow the "best practice" guidelines.
Now, imagine what happens when the science isn't clear.
That was the case Monday, when the U.S. Preventive Services Task Force updated its guidelines for breast cancer screening. After analyzing the best studies, the influential panel now suggests most women get a mammogram every other year, beginning at age 50. Guidance from this task force largely determines which tests will be covered by Medicare, Medicaid and insurance companies.
Meanwhile, the American Cancer Society and the American College of Radiology still recommend annual screening mammograms for women beginning at age 40.
"There's really a lot more ambiguity about what is the right thing — what's appropriate [and] what's not appropriate," says Dr. Albert Wu, an internist and professor at the Johns Hopkins Bloomberg School of Public Health.
In cases like these, Wu says, doctors are more likely to follow their gut instincts. And when that happens, fear often comes into play.
Imagine, for example, that a healthy, 40-year-old woman walks into your office and asks about a mammogram.
"If that woman were to develop breast cancer or to have breast cancer, you can imagine what might happen to you if you didn't order the test," Wu says. "Maybe you'd get sued."
Doctors often hear stories like this, he says, and that can affect their judgment.
"Emotion and recent events do influence our decision-making," he says. "We are not absolutely rational, decision-making machines."