Bioterrorism, Malpractice, Clinical Guidelines, Direct-To-Consumer Ads, Health Care
Since the terrorist attacks of Sept. 11, primary care physicians have seen an increase in patients suffering from stress-related illnesses, according to an online survey of FPs, GPs, and internists. Two out of five respondents said they're prescribing more medication for depression or anxiety, while one in four reports referring more patients for counseling. But the doctors have some qualms about their ability to respond effectively to a biological warfare agent. Nearly a third of the respondents believe they are inadequately prepared for the task, and nine out of 10 said they need more training in recognizing symptoms and responding to potential threats.
The survey of 591 physicians was conducted by Cozint, a pharmaceutical market research company.
To prevent frivolous malpractice suits, many states require plaintiffs' lawyers to file a report from a qualified medical expert confirming the legitimacy of the claim that the physician defendant violated the standard of care. But a North Carolina appellate court has ruled that the law requiring precertification violates the state constitution's guarantee of access to the courts to redress a wrong. According to the majority opinion, the law imposes a financial burden not faced by plaintiffs in other types of lawsuits.
The defendants have appealed the ruling to the North Carolina Supreme Court, with support from the state medical society, which fears that the appellate decision, if upheld, will open the floodgates to frivolous malpractice claims.
A physician's noncompliance with clinical guidelines may reflect valid skepticism about the applicability of "best practice" measures to an individual patient.
That's one finding of a new study published in Effective Clinical Practice. It involved 85 internists who volunteered to try to improve their outpatient practices. Doctors filled out questionnaires at the point of service for 25 patients with type 2 diabetes, reviewed their own charts, and offered explanations for not following treatment guidelines.
In some instances, doctors said they decided not to adhere to the guidelines because of the patient's age, comorbidities, or more-pressing medical problems. Other explanations included patients' refusal to follow treatment regimens, problems with continuity of care, and practitioners' forgetfulness.
Overall, noncompliance was identified in about one out of four cases. Because the data reflect only self-reports by the volunteers, researchers estimate that noncompliance is higher in overall medical practice.
Spending on direct-to-consumer drug advertising increased from $266 million in 1994 to nearly $2.5 billion in 2000, largely because of growth in television advertising. Since 1994, spending on consumer drug promotion has risen at an average rate of 45 percent each year. Yet, according to a recent survey from Kaiser Family Foundation, the ads do little to educate the public about the medical problems they address or the treatment options they tout.
Indeed, 70 percent of the 2,511 people polled said they had learned little or nothing about specific health conditions from these ads, and 59 percent said they had learned little or nothing about the drugs.
The events of Sept. 11 have led to major changes in Americans' attitude toward health care issues, according to polls conducted by the Harvard School of Public Health and Harris Interactive. Policies that were being debated in Congress before the terrorist attacksMedicare reform, a prescription drug benefit, patients' rights legislation, and coverage for the uninsuredno longer take center stage. Concerns about health care problems related to terrorism now tie with cost as the health care issue the public perceives to be the most important.
Joan Rose. Practice Beat. Medical Economics 2002;1:16.