UIC study checks competence of doctors

July 19, 2010

Some actors pretending to be real patients went undercover in Chicago and the Milwaukee area.

The results?

In a new study, researchers from the University of Illinois at Chicago discovered many physicians are missing red flags in those who need special care.

When you go to the doctor, you're generally asked what is wrong, what are your symptoms? You describe them and a diagnosis is made. This is usually based on years of science and specific medical guidelines. But a new study in the Annals of Internal of medicine finds patients often receive inappropriate care when their doctors fail to also check up on personal situations.

"Sometimes following the guidelines is the wrong thing to do," said UIC internist/pediatrician Dr. Saul Weiner.

Weiner headed up the study that used actors trained to simulate real patients. The visits were recorded and the doctors were rated on performance. Seventy-three percent provided error-free care when customary practice was all that was needed.

But, the study says, only 22 percent of physicians provided appropriate care when a patient had a back story to their illness. Meaning many doctors missed red flags or verbal hints from the patient that something in their life was impacting the direction of their disease.

For example, a patient comes in complaining his asthma is getting worse. Doctors who inquired further found out the patient lost his job and health insurance , and consequently wasn't taking his medication regularly.

"Good medical practice clearly involves another step, it involves knowing when you have to individualize care," said Weiner. "That is not the same as following the guidelines. It often means not following the guidelines and that we are not measuring."

Dr. Weiner says a dramatic change in the way physicians are trained and rated would help.

And, surprisingly, this study's results did not seem to be about doctors being rushed.

"We found that those who did well didn't spend any more time with patients than those who did poorly," said Weiner.

This research was funded by the Department of Veterans Affairs and is said to be the largest study ever of physician performance using undercover actors.

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