Medpage Today ran the entertaining story of the fabled crow who quenched his thirst by tossing stones in a pitcher of water to raise the water level.
Prior to the COVID crisis, it had taken almost seventeen years on average for new therapies to reach clinical practice. To say that the speed of medical decisions during the crisis accelerated would be a gross understatement.
One of the many challenges that faced physicians during the crisis was to keep current with the ongoing changes to available data. But they tried and they did.
The fight is not over yet but with the improved number of vaccinations worldwide, much of the anxiety has eased where vaccines have become available.
The question presented in this article is whether the momentum will continue.
A Physician’s Viewpoint
A physician reports that he uses the electronic health record (EHR) system in his practice but he calls it just expensive paper charts that document decisions after he makes them. He feels that it does not help him make better decisions.
Then there are the pop-up alerts that warn of drug interactions. With all the other online traffic, he finds the pop-ups to be just a distraction.
The doctor suggests that in order to facilitate receipt of clinical guidelines, intelligent decision support should be included in the EHR.
He suggests that when inputting the patient’s information in the EHR, adequate support should include questions to ask the patient to ensure the patient’s history is complete.
And the EHR should suggest other potential diagnoses as well as list medications that have proven efficacy.
This is yet another example of necessity being the motivation for an innovative idea. Dr. Sanjeev Arora, who had been in practice as a liver specialist for 41 years, had seen patients with hepatitis C complications that he felt could have been prevented with timely therapy.
Dr. Arora’s challenge was to find a way to reach as many physicians as possible in New Mexico. He developed a system whereby primary care physicians within the community presented their cases to specialists at Dr. Arora’s medical center through video conferencing. The program was successful. It presented various examples of actual patient care for hepatitis C.
Dr. Arora and his colleagues followed up with a paper in the New England Journal of Medicine. They proved that the primary care physicians who made use of their video conferencing became equally skilled at managing hepatitis C.
Approximately two million scientific articles are produced each year. In addition, new guidelines for every major disorder are issued every one to three years. Physicians also receive FDA advisories, meaning that they have a lot to keep up with.
A Novel Idea
Dr. Marty Makary, editor-in-chief of MedPage Today and a surgeon-researcher, created a successful program in which physicians could be graded on physician scorecards.
He sent letters to hundreds of Mohs microsurgeons reporting their surgery performance compared to their peers. Mohs surgery is a procedure used to treat skin cancer. There were no rewards for outstanding performance. The purpose of the reports was strictly for comparison.
The results proved to be remarkable and resulted in drastic changes in behavior. Physicians who lagged behind their peers eventually saw an eighty-three percent improvement in their performance.
It appears that the scorecards were successful because they originated from a peer and were designed not for punishment or even reward but simply as a learning experience.
Will the Speed of COVID Response Continue?
Although the pandemic demonstrated that a better response to medical science is indeed possible, it is not sustainable. The recent extraordinary pace occurred because of daily headlines and a constant sense of urgency. This is not the norm. The average physician manages hundreds of conditions each year. The pace of COVID’s rapid testing would not be possible on a continuous basis.
Last Year’s Changes in COVID Testing
- Nasal PCR administered by healthcare professional
- Weeks later patients could test themselves in the presence of a healthcare professional
- Weeks later patients could test themselves at home
- Weeks later saliva PCR tests, antibody, and antigen tests were available
- New information was announced periodically about new tests by various manufacturers
- Abbott Lab’s 15 minute PCR test became available only to be recalled due to a high number of false negatives
And yet, medical practice managed to keep pace with the changes. Although the pandemic was responsible for updating the clinical practice, maintaining a reasonable but more rapid pace is in the hands of our physicians.