Quotes of the Day

Nearly half of American adults don't get the sort of health care they should, according to a report published in this week's New England Journal of Medicine. Whether it is on-time colonoscopies, recommended flu shots or annual physical exams doctors and patients are both remiss about following existing health care guidelines for a number of diseases, the report says. Researchers sampled 12 metropolitan areas in the U.S. and looked at 439 indicators of quality care for 30 different health conditions and found this was true not only for uninsured, impoverished or rural Americans — but for those with good health insurance as well.

Medical specialty groups have for years been developing these "best-practice" guidelines, based on evidence from clinical trials, in an effort to improve and standardize medical care. In this study, researchers found a significant variation between actual practice and best practices. Overall, participants in the study received only 54.9% of recommended care. Some specific examples: only 1/4 of diabetics received regular blood sugar checks, 55% of heart patients were not given proper medication and only 38% of adults underwent colorectal cancer screening as recommended by the American Cancer Society. Interestingly, senile cataract patients received on average nearly 80% of recommended care while alcoholic patients only 10% of recommended care.

But it's not as bad as it looks. Yes, doctors have to do a better job. But it's virtually impossible to keep up with constantly-changing procedures. While leaders in the health care industry have for years discussed ways to improve, no real change will come about until health care providers make better use of information technology. As a doctor, I know firsthand it is impossible to commit ever-shifting guidelines to memory. As Dr. Earl Steinberg, the writer of an accompanying editorial in the "Journal" notes, "it is ludicrous to expect physicians to comply consistently with hundreds of practice guidelines without the support of a computerized infrastructure." Some doctors have increasingly turned to computer-based systems as support tools and guideline reminders. They have also increasingly begun email communication with patients, which can provide an easier and more effective way to communicate.

Patients also bear a responsibility. Perhaps the biggest barrier to good preventative medicine is that most of us only go to the doctors when we are sick. We don't see the value to our health or our pocketbook to getting checked early and often. Indeed, a strict adherence to all of the existing health guidelines would be expensive and cumbersome. While it's likely these efforts will ward off more expensive and devastating disease in the future, Steinberg writes "those savings may not be realized for 5 - 10 years" — or even longer. In the end, the best medical care is care that prevents you from getting sick. People should always be looking to promote good health through exercise, diet and vigorous lifestyle changes — and make sure to follow the advice of their doctor.

• Sanjay Gupta, M.D.
• A new study says doctors don't follow patient-care guidelines. That's only part of the problem