American College of Physicians: Internal Medicine — Doctors for Adults ®


Convincing doctors to follow guidelines

From the June 1996 ACP Observer, copyright © 1996 by the American College of Physicians.

By Deborah Gesensway

The more experience doctors have with medical practice guidelines, the more they know how difficult it is to get doctors to adopt them, said panelists at a workshop on implementing guidelines.

Addressing a roomful of internists who said they are drafting guidelines for their health care organizations or trying to convince their peers to follow guidelines, the panelists suggested a two-pronged approach for convincing doctors to get on board: First, write guidelines that are relevant. Second, address all the factors that influence physician behavior.

"What we've learned is that changing physician behavior is a complex issue. Simple dissemination of information is generally not effective," said Sean R. Tunis, ACP Member, who has studied guideline development and implementation for the U.S. Office of Technology Assessment. He said physician behavior is affected by such pressures as public opinion, patient desires, financing rules, regulations, legal concerns and physicians' attitudes about the source and motivation behind a guideline.

According to Stephen C. Deutsch, ACP Member, of Cedars-Sinai Medical Care Foundation in Los Angeles, physicians are most likely to accept guidelines that are developed by a physician organization, based on scientific evidence, updated frequently and flexible. "We don't want to keep you on the pathway if you shouldn't be there," Dr. Deutsch said.

Additionally, he said, the guideline's purpose must be linked to outcomes or else it will either increase costs or not improve the quality of care.

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