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Friday, January 7, 2011

Is your doctor out of date?

"Is your doctor out of date?" That's a valiant question, and the title of a Reader's Digest article from the November, 2009, issue.

Of interest to learn is that while asthma used to be treated as an acute disease, whereas doctors would wait until an asthmatic had an attack and treated the symptoms, asthma experts now recommend using asthma controller medicines, preferably inhaled corticosteroids, to PREVENT asthma.

Yet, evidence shows that only 50% of the 9 million asthmatic kids are currently on inhaled corticosteroids, either because their doctors didn't prescribe them, or they weren't told to continue to use them when they were feeling well.

The old way of treating high blood pressure was to tell people to eat better and live better, although the new method is to make sure any person who has a blood pressure higher than 140/90 you need to be on one or more blood pressure medicine to bring it down to normal.

Past evidence showed that less than 10% of those with high blood pressure made the necessary changes to lower their blood pressure, which is why the "guidelines" for treating high blood pressure were changed.

It used to be that for those with back pain, an x-ray was taken, perhaps an MRI, and sometimes even invasive surgery was performed. Yet, evidence shows none of those ever did any good, and often resulted in unnecessary and painful procedures that did more harm than good.

New guidelines focus on encouraging exercise and heat pads to overcome the pain, and only going the next step if there is severe weakness, a history of cancer, or problems urinating.

While evidence show clot busting medicines like Asprin, angioplasty and other "proven steps" have been proven to make a big difference in outcomes of those having a heart attack, evidence shows fewer than 50% were getting clot busters, and 25% referred for other treatment.

Since then efforts have been made to get the word out.

All humans are creatures of habit, which makes all of us, in a way, set in our ways. This is why experts have come up with guidelines that are updated, and have made efforts to continually educated not just doctors, but patients and family members to.

As noted by the article, "when your doctor suggests a treatment, you should hear the word evidence in his or her explanation."

Yet, still, a guideline is still a guideline. There are times when common sense should prevail. A good example is the asthma guidelines, which state if you use your rescue medicine more often than 2-3 times in a week your asthma is not controlled.

But sometimes you have a hardluck asthmatic who does all the right things, yet still has trouble with his asthma. In this case, the asthmatic may have good control and still require to use his rescue medicine a few times a day.

So, is your doctor out of date? He might be, and therefore it's your job to know, to do your research, and to nudge him or her in the right direction if he or she is.

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