Doctor's Orders: The challenges of evidence-based medicine. And the difficulty of measuring it.

Doctor's Orders is a collaboration between MedPageToday and ABC. In a recent feature, Practicing Evidence-Based Medicine Is a Challenge, physicians discussed some of the hurdles. They also discuss the substantial difficulties of really knowing how many diagnoses aren't in keeping with current evidence. "With the amount of research being published in medical journals and presented at meetings, it should not be surprising when a new finding slips by a busy physician. Nor should it be surprising, then, that some decisions about patient care might be made without benefit of the most recent evidence.

"Although experts interviewed by MedPage Today agreed that keeping up with the most current information is challenging, it's unclear exactly how widespread the phenomenon of the outdated doctor is. 'To some degree or another, I think it's very widespread,' said Richard Deyo, MD, MPH, a professor of evidence-based family medicine at Oregon Health & Science University in Portland. But he added that it's not a black-and-white issue, because physicians can be up to date in one area and lagging behind in another. 'I think we all are sort of somewhere along a continuum,' he said."

"Lori Heim, MD, president of the American Academy of Family Physicians, agreed that it's difficult to put a solid number on how many doctors are practicing outdated medicine. She said a good place to start would be with the numerous studies that have found that many patients do not receive recommended care for various conditions. One such study, released in the New England Journal of Medicine in 2003, reviewed the care received by surveyed adults in the two years preceding a telephone interview. A review of their medical records found that only 54.9% of the time did they get the care recommended for their condition.

How do you really know? "However, Heim said, one can't conclude from that data that the other 45.1% of the care was delivered by doctors who were not up to date on the most recent evidence. Perhaps, for instance, a diabetic patient was scheduled to come in for hemoglobin A1c screening but missed the appointment. That might have been listed as a failure to get the recommended care, said Heim, a hospitalist at Scotland Memorial Hospital in Laurinburg, N.C."