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Are Medical Advances Developing too Fast for Doctors to Embrace?

"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 happen."

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 Carter.

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 HealthScoutNews

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