Unaware, Unconvinced, Unable, Unclear: Why Doctors Don't Follow Treatment Guidelines

The evidence shows that your doctor is not very good at complying with treatment guidelines. Whether it is to prescribe statins for your cholesterol or whether or how to prescribe antibiotics for many conditions, a disturbing number just don't follow guidelines. Why? Probably because they are unaware, unconvinced, or unable, or the guidelines are unclear.

UNAWARE: Doctors just are not aware of the guidelines or they have an incomplete understanding of them. Given the explosion of medical information and how frequently recommendations change, it is understandable.

UNABLE: Even if doctors wanted to comply with treatment guidelines, cumbersome policies and procedures where they work prevent them from doing so. Want to sit on the phone for an hour getting prior authorization? Want to see if the drug is in the insurance formulary for hundreds of different plans? Want to see what it will cost or if the patient can afford it? Want to see if a certain test is advisable? Good luck

UNCONVINCED: The party line goes, "Don't tell me how to practice cookbook medicine. My patients are different." Of course all patients are different. In many instances, though, their response to treatment will fall within two standard deviations.

UNCLEAR: The guidelines are difficult if not impossible to interpret or apply to a given set of circumstances. They are filled with language that is wishy washy or not definitive. Plus, do you really want your doctor to spend the 20 minutes of your appointment downloading a 46-page PDF from a society website to get up to speed?

Improving adherence to practice guidelines is both a quality, behavior change and a business opportunity for improvement. However, getting there will mean doing a better job of getting into the heads of docs and addressing the barriers.