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April 12, 2011

Doctors Don't Always Take Their Advice (ENT Perspective)

Reuters published an interesting story about research that showed doctors don't always recommend treatments to patients that they themselves would pursue if they were sick. In essence, if the doctor was the sick person, they would tend to pursue treatments that carry a higher risk of death but fewer severe side effects whereas patients pursue the exact opposite.

Though the clinical scenarios illustrated in the article/research is not reflective of an ENT practice (colon cancer and bird flu), I do see it quite often in other scenarios... the biggest one being when to perform a tracheostomy... hole placed in the throat for breathing purposes often performed in very sick patients in the ICU.

Trachs are often refused by the patient's family for as long as possible... even weeks until all other avenues have been exhausted before considering a trach.

Although this procedure may sound "scary" and many patients and their families automatically refuse to consider such a procedure, the following (unofficial) survey done on Sermo (online physician community) on February 19, 2008 on physicians nationwide may be illuminating on how worthwhile having this procedure is to recovery.

When US physicians were polled at what point they would consider a tracheostomy on themself or their loved one if prolonged intubation was expected, 50% stated trach should be done within the first 8 days of intubation of which 28% wanted it to be performed within 3-5 days. Only 15% would desire a trach after 12 days or longer intubation.

Read the Reuters story here.


Reference:
Better off not knowing: improving clinical care by limiting physician access to unsolicited diagnostic information. Arch Intern Med. 2011 Mar 28;171(6):487-8.
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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