Why Physicians Don’t Always Follow Best Practices

For instance, with the AAO-HNS tinnitus guidelines, hundreds of suggestions were made during the peer review and public comment period, which led to improvement of the guidelines, he said.

Jeremy Meier, MD, assistant professor of surgery at the University of Utah in Salt Lake City, whose research has found that many surgeons still routinely give antibiotics for tonsillectomy despite a guideline recommending against that practice, said physicians need to be made aware of their outcomes and guideline adherence. “Surgeons need to know their own data and their own outcomes,” he said. “Anecdotally they may think that they’re providing the best practice, but if they truly were to go back and look at their outcomes they may see that giving the antibiotics or not really didn’t make a difference.”

Dr. Stern said that the non-stop onslaught of e-mails that physicians receive daily, along with pressure to comply with insurance and quality measures, means that guidelines can get lost in the shuffle. “Every day, I have at least 10 e-mails of different things that I’m supposed to review,” she said. “I worry that when academies come out with guidelines mixed in the queue of all of these e-mails that need to be opened up, something has to give. How much are you going to read? Employed physicians have so many additional mandates within their own system to follow, it is hard to find the time to read everything.”

Involving Patients

She said the AAO-HNS is hard at work making sure the guidelines are accessible to everyone—to healthcare providers and patients alike. She would welcome a universal electronic health record with guideline information embedded as a way to make sure physicians are informed. but that’s clearly easier said than done, she acknowledged.

She is now working on making guidelines more accessible to healthcare providers and more easily searchable online. “One of the things that I myself have discovered is that if I try to use lay terms to search some of our older guidelines, they are not as accessible as you’d like them to be to a patient,” she said. “A lot of other things come up first. Patients are our partners in good healthcare and our guidelines are accompanied with great patient-oriented summaries. We need to make sure that the patient can find them easily.”

Dr. Tunkel agreed. “I really think that the way the clinical practice guideline community is going to adapt is it’s going to come through patients.” He noted that guidelines are developed with patient representatives involved and already come with a plain-language summary intended for patient consumption.