Dr Derek Raghavan Outlines Challenges to Implementing Evidence-Based Guidelines

Physician belief in the art of medicine is running up against the challenge of costs being shifted to patients and health systems and the desire of payers to have less variation in care, said Derek Raghavan, MD, PhD, FACP, FRACP, president, Carolinas HealthCare System's Levine Cancer Institute.

What are the culture challenges that make it difficult for health systems and practices to implement evidence-based guidelines?
It's becoming increasingly challenging to structure our approach to medicine, and there are a whole bunch of issues that get in the way. I think the first, and most important one, is the territorial imperative of the physician. Most physicians like to be independent, they believe in the art of medicine; they feel there is a nuance that will be available with their own personal skill. And, to be truthful, there is something to be said for that. The art of medicine is important. The more experienced physician is going to be, probably, better than the less experienced physician. Part of the difficulty is that some of the art of medicine is predicated on opinion rather than fact.

The second issue that is very challenging at the moment is the fact that we can no longer provide the medical care that we have traditionally with the money that's available to support it. Costs are being shifted to patients; costs are being shifted to healthcare systems. So there's a tension that is driven by that. The people who pay for healthcare—whether it's governments or health insurance funds—are looking for less variation and more structure and a bigger evidence base.

There has been a symposium at the American Society of Hematology meeting focused on the use of guidelines and how to disperse those guidelines into clinical practice, thinking about the impediments to the use of guidelines by physicians.
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