Why don't doctors follow directions? Lack of information, confidence, time & readiness to change, says new study

ANN ARBOR, Mich. - A surprising percentage of doctors are not following national guidelines that could help them treat patients better because they don't have enough information, time, or readiness to change - or enough confidence in their ability to do everything the guidelines recommend, according to a new study.

When it comes to guidelines for preventive health advice, lack of confidence is the most likely reason physicians give for not following recommendations. But better educational efforts could help reverse this tendency and ensure that patients get consistent and up-to-date care, say the authors of a report published in the Oct. 20 issue of the Journal of the American Medical Association.

The study reviewed the results of 120 physician surveys, contained in 76 scientific papers published over the last 30 years. In each, doctors reported the biggest barriers of knowledge, attitudes and behavior that keep them from following the medical guidelines for specific diseases. The study was conducted by Michael Cabana, M.D., MPH, a pediatrician and lecturer in pediatrics at the University of Michigan Health System, and his former colleagues at the Johns Hopkins School of Public Health.

The authors have all been involved separately in the development of different practice guidelines, and pooled their resources to look at the problems facing the implementation of such guidelines in general.

"Despite the fact that physicians have evidence-based guidelines at their disposal for dozens of conditions, they're having similar problems across the board in implementing them in their own practice," says Cabana. "If these guidelines are going to have an impact on the way patients are treated, we need to understand the barriers that exist and find ways to overcome them."

Increasingly over the past 10 years, a number of medical societies, government agencies and non-profit groups have gathered experts to examine the current state of knowledge about diff

Contact: Kara Gavin
University of Michigan Health System

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