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medpundit |
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Monday, November 10, 2003Doctors have known for a decade that drugs called ACE inhibitors are a cornerstone of care for congestive heart failure, yet a nationwide survey released yesterday shows that nearly one-third of patients are sent home from the hospital without this lifesaving treatment. The report documents what many see as a dangerous reality of modern medicine: Doctors often fail to offer, or simply don't know about, the most basic elements of care for the many conditions they see daily. Just why doctors do not give patients the treatments that experts universally agree work best is not always clear, although those who study the situation say the reasons probably range from forgetfulness and haste to ignorance. The accusation is based on a study that looked at how many people discharged from hospitals with a diagnosis of congestive heart failure went home with a prescription for an ACE inhibitor, a class of drugs that's been shown to improve heart function and outcomes for that disease: The newest survey found that 31 percent of patients considered ideal candidates for ACE inhibitors are sent home without them. Even at elite teaching hospitals affiliated with medical schools, more than one-quarter don't receive them. First, let's put the study's findings into perspective - 69 percent of patients do go home with ACE inhibitors. Now, why do one-third of heart failure patients go home without them? Maybe because one-third of the patients in the study had contraindications or side effects. When you consider that one side effect alone, cough, occurs in up to 20% of people who use ACE inhibitors, then you can understand why a third of people might go home without them. (The cough is often mild but annoying enough that people beg to stop the drug to be rid of it.) It's hard to tell from the story if side effects and contraindications were taken into account by the study, since it was based on a paper presented at a meeting rather than one published in a journal. However, studies that involve matching discharge diagnoses with treatment seldom take the time to track down such nuances. It's too labor intensive and time consuming to read through all of the charts. Which brings us to the problem of guidelines and the studies that evaluate their implementation. The purpose of guidelines is just that - to guide therapy. But the message inherent in studies like this is that guidelines should be the standard of care for everyone. There's just one problem. Although a drug or treatment may, on paper, confer the greatest advantage for the treatment of a disease, in the real world not every drug or treatment can be applied equally to all people. In the real world, drugs have side effects. In the real world, each patient's situation is unique. And in the real world, treatment has to be tailored to the individual patient. To do otherwise is just bad medicine. posted by Sydney on 11/10/2003 06:37:00 AM 0 comments 0 Comments: |
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