Introduction

Reviews

Is Your Doctor Out-of-Date?

Timothy B. McCall, M.D.

To stay current, physicians must read medical journals, attend conferences and review new medical textbooks. A study from the Annals of Internal Medicine suggests that many doctors may not be doing enough. Over 700 doctors were surveyed about their knowledge of recent advances in medical practice. For example, a test that has been around for more than ten years, called a hemoglobin A1C, has been shown invaluable in assessing how well-controlled someone’s diabetes is. Dozens of articles on how to use it have appeared in medical journals and in textbooks. Nonetheless, 65% of doctors in general practice and 36% of internists didn’t understand how to use it correctly. The study found that these doctors were also ignorant of other widely disseminated advances.

When trying to evaluate how up-to-date to date a physician is, keep the following in mind:

• When doctors complete their training, they are generally well-versed in current medical practice. Although they may lack experience and the judgment and perspective that comes with it, newly trained doctors will be familiar with the latest drugs, have used the latest medical technology and have treated patients with newly-discovered medical conditions like AIDS or Lyme disease. Many doctors, however, practice the same brand of medicine they learned in training, even if their training was 30 or 40 years ago.
• Older physicians are more likely to be out-of-date but those who make the effort to stay current, combine their broad knowledge with a wealth of experience. The world’s most respected medical teachers and authorities tend to be gray-haired. On the other hand, the absolute worst physicians I’ve ever seen were older. There is no mandatory retirement age for physicians, which is as it should be since some remarkable individuals retain their skills into their 80s and beyond. These doctors, though, are probably more the exception than the rule. According to the Boston Globe, 40% of the suspensions, censures and other punishments for prescription violations in Massachusetts in one recent year were taken against doctors over 65. Yet these doctors made up only 8 percent of licensed physicians and many of them practiced only part-time.
• A doctor who is up-to-date in one area may be badly behind-the-times in others. A cardiologist may be well-versed on the latest treatments for angina or high blood pressure but know little about developments in diabetes or in asthma. Since many specialists also deliver primary care, there is a greater risk of their being out-of-date when they step out of their area of expertise. This is particularly true of doctors whose specialties involve performing a lot of procedures, like cardiologists and intestinal specialists (gastroenterologists).
• The best way to assess how up-to-date your doctor is, is to know something about your medical conditions. The more you know, the better you’ll be able to assess your doctor’s knowledge. If you have asthma, for example and you’ve been doing your reading, you’d know that expert opinion on treatment has changed radically in the last several years. The drug theophylline, which was once the mainstay of asthma treatment, has largely been supplanted by inhaled medicines.
• Asking questions can help you to assess how up-to-date your doctor is. You could ask about a medical condition that’s been in the news. Ask, for example, "If someone has an HIV test and it’s negative, does it definitely mean they’re not infected?" Any doctor who is even reasonably current, will know that because of the so-called “window period,” the test can take up to six months to become positive. The correct answer is that the longer the time that has passed since the time of possible infection, the lower the chance of a false negative.
• A doctor who prescribes the latest drugs or orders fancy high-tech tests is not necessarily up-to-date. Doctors who are behind-the-times are often inordinately swayed by promotional efforts by drug companies and are more likely to prescribe the latest highly-advertised drugs. And when new drugs or tests are ordered by doctors who don’t understand them well, the risk of improper use or unrecognized side effects increases. On the other hand, the use of out-moded drugs or tests can be a clear indication a doctor has not kept up.

As important as up-to-date knowledge is sometimes its value is overstated. It is not the same thing as high-quality medical care. Some doctors who are current in their knowledge are lacking in other ways.

On the other hand, if you have a physician who is a little behind-the-times but who is otherwise thorough, compassionate and communicative, you may be able to get excellent care. You just may want to do a more reading about your medical conditions and get second opinions a little more often

Next: Is Your Doctor Practicing Good Preventive Medicine?