Doctors must sort thru too much info
Healing the Overwhelmed Physician
By JERRY AVORN, NYT
BOSTON — DURING an 1817 visit to Florence, the French author Marie-Henri Beyle, known by the pen name Stendhal, was seized by palpitations, dizziness and a feeling of being overwhelmed by the abundance of great art surrounding him; an Italian psychiatrist later coined the term Stendhal syndrome to describe this phenomenon.
We physicians are susceptible to a kind of medical Stendhal syndrome as we confront the voluminous evidence about the clinical choices we face every day. It would take dozens of hours each week for a conscientious primary care doctor to read everything he or she needed in order to stay current — a dizzying and impractical prospect.
To remedy the problem, many medical groups issue clinical-practice guidelines: experts in a field sort through the reams of clinical research on a medical condition and pore over drug studies, then publish summaries about what treatments work best so that physicians everywhere can offer the most appropriate, up-to-date care to their patients.
While this sounds straightforward, the process can go astray. Take, for example, the recommendations issued recently by the American Association of Clinical Endocrinologists on caring for patients with diabetes. The A.A.C.E.’s latest guidelines elevate many second- or third-line drugs to more prominent positions in the prescribing hierarchy, rivaling once uncontested go-to medications like metformin, an inexpensive generic. They also emphasize the riskiness of established treatments like insulin and glipizide, which now carry yellow warning labels in the A.A.C.E. summary.
(Continued here.)
BOSTON — DURING an 1817 visit to Florence, the French author Marie-Henri Beyle, known by the pen name Stendhal, was seized by palpitations, dizziness and a feeling of being overwhelmed by the abundance of great art surrounding him; an Italian psychiatrist later coined the term Stendhal syndrome to describe this phenomenon.
We physicians are susceptible to a kind of medical Stendhal syndrome as we confront the voluminous evidence about the clinical choices we face every day. It would take dozens of hours each week for a conscientious primary care doctor to read everything he or she needed in order to stay current — a dizzying and impractical prospect.
To remedy the problem, many medical groups issue clinical-practice guidelines: experts in a field sort through the reams of clinical research on a medical condition and pore over drug studies, then publish summaries about what treatments work best so that physicians everywhere can offer the most appropriate, up-to-date care to their patients.
While this sounds straightforward, the process can go astray. Take, for example, the recommendations issued recently by the American Association of Clinical Endocrinologists on caring for patients with diabetes. The A.A.C.E.’s latest guidelines elevate many second- or third-line drugs to more prominent positions in the prescribing hierarchy, rivaling once uncontested go-to medications like metformin, an inexpensive generic. They also emphasize the riskiness of established treatments like insulin and glipizide, which now carry yellow warning labels in the A.A.C.E. summary.
(Continued here.)
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