What Your Doctor Doesn't Know Can Hurt You

Seventeen years is the average lag time between the discovery of more effective forms of treatment and their incorporation into routine patient care.

If you have teenagers, you’ve undoubtedly seen their eyes roll when you talk about how things were “back in the old days” before they were born. You can hardly blame them. Seventeen years is an eternity in our fast-paced world, and we’ve all become accustomed to the advantages that modern science and technology brings to our lives. But despite all of those advances, the medical care we receive today is likely based on clinical guidelines that were developed in the late 1990s.

That ought to get even your teenager’s attention.

Seventeen years is the average lag time between the discovery of more effective forms of treatment and their incorporation into routine patient care1

How is this possible? This statistic runs directly counter to every reasonable expectation that physicians will have access to the latest medical evidence and clinical guidelines for best practices and will provide care based on that information. What if your mechanic was using 17-year-old diagnostics to service your car? Or your network technician used 17-year-old computer manuals? How is our health held to such a vastly different standard of up-to-date requirements for care?

As your teen might say: It’s complicated.

The process to develop clinical guidelines can be very long. Steps required include systematically reviewing published research, rating the available evidence, developing recommendations that can be implemented in practice, and establishing follow-up to gauge the quality and usefulness of the developed guidelines. That all takes time—years, in many cases.

Even once guidelines are developed, there’s no guarantee that they will be implemented by individual physicians. There are a number of reasons for that. Care providers vary significantly in their attitudes toward new research, their ability to implement it, and even their awareness that the research exists. The number of published peer-reviewed medical journal articles is now over 800,000 per year—much more than any working physician can hope to read in a lifetime. A significant part of the problem is simply figuring out a way to deliver the right information to the right provider at the right time so that he or she can apply it to the patient at the point of care.

This last issue is a huge part of the problem, and is one that any 17 year old could solve with one word: Technology.

Google didn’t exist 17 years ago, but your teen can’t imagine a world without it. Similarly, knowledge systems are beginning to have a tremendous impact on the practice of evidence-based medicine. The proliferation of published research, the effort to translate research into guidelines, and the need to consume it within a physician’s current workflow can be overwhelming. But technical advances can now deliver the latest applicable evidence-based guidelines directly to the point of care, within existing workflows.

What’s more, the solution can be applied across entire populations. This is where the Triple Aim comes into play, establishing consistent delivery systems of care that improve the individual experience, improve the health of populations, and reduce the per capita costs of care for populations. By providing care delivery that it is based on the best available evidence, we can begin to eliminate variation, disparity, and inefficiency, leading to higher quality care, better access, and lower cost.

As your teen might say, that’s a no-brainer.

1 Balas, 2001; Institute of Medicine, 2003b

J. Siemienczuk, MD