EBM12: Healthcare is 'complicated, humbling'

CHICAGO--Clinicians must be careful not to bring their own biases to their patient care, said David A. Kessler, MD, former FDA Commissioner, speaking during a question-and-answer session on moving evidence-based medicine from theory to practice at the CMIO Leadership Forum: Transforming Healthcare through Evidence-Based Medicine.

Kessler said that through his work with the Elizabeth Glaser Pediatric AIDS Foundation Glaser, he found that many providers thought that people didn’t know how to take combination of antiviral drugs. But, he said of the people in rural parts of South Africa, “their compliance would far exceed that of anyone in this room to follow a medical regimen.”

Sameer Badlani, MD, CMIO at the University of Chicago Medical Center, said “really interacting with the patient in their home environment is going to make the difference” in the future of healthcare. When providers lecture patients in their office, the patient goes home without remembering much of the information. Reminders in the home environment, perhaps using simple text messaging is “showing great potential,” he said. “We need to focus on taking care out of the hospital and the physician office and personal health records will take us there.”

Meanwhile, Kessler said, “We’re kidding ourselves where we’re heading in healthcare. Fat, sugar and salt really does affect the neural circuitry,” which is extremely difficult to change. “If 30 percent of this country is going to be diabetic by 2030 we’re in serious trouble as a country.” As radical as it sounds, he said, we could reach a point where those who are overweight pay more for healthcare.

Michael S. Blum, MD, CMIO at the University of California San Francisco Medical Center, pointed out that very few of the mobile device apps created to support wellness “stick” to effect-sustained behaviors.

Physicians “own” some of the current healthcare problems, said Carolyn M. Clancy, MD, director of the Agency for Healthcare Research and Quality. “We shouldn’t be shocked that many people, after an invasive procedure, don’t take their medicines. From a reimbursement point of view, it’s not worth the surgeon spending even 90 seconds talking about it. They figure ‘let someone else do it’ and they move on to the next procedure.”

Clancy said it would be interesting to know what doctors do for themselves when it comes to prostate-specific antigen (PSA) screening. The feedback from the task force recommendations on PSA screening included a fair number of notes saying ‘thank you’ or saying ‘I had the test, surgery and follow-up treatments and that was right for me.’ That’s an incredibly important bit of evidence to have in front of the public.” She expects to see more activism from physicians in the future.

“When I was in Washington,” Kessler said, “I was amazed how diverse this country really is. It’s complicated and humbling. We have to respect the diversity and understand that is going to continue despite our best efforts.”

The conference was produced by Clinical Innovation + Technology and Clinical-Innovation.com. The event was sponsored by Elsevier ClinicalKey.