While interviewing sources for my story on evidence-based medicine for this month's issue of HealthLeaders magazine, one surprising sentiment came up over and over. The healthcare leaders and industry experts I spoke with said some docs don't like decision support technology because they think it makes them look dumb.
When face-to-face with a patient, these sources say, docs don't want to seem reliant on finding the answers on a computer. Is it true?
Well, one study suggests that it is. In the study, researchers read various scenarios to waiting room patients about physicians who used decision support and heeded the recommendation or ignored it in favor of a less aggressive or more aggressive treatment. Participants in the 2008 study, published in the journal, Medical Decision Making, "always deemed the physician who used no decision aid to have the highest diagnostic ability" on a five-point scale, the researchers said.
James Wolf, an associate professor of information systems at Illinois State University's School of Information Technology who studies physician adoption of—and resistance to—technology, saw similar results in his most recent studies. In one, even tech-savvy undergraduate and graduate computer science students preferred physicians who rely on intuition instead of computer aids.
"Patients object when they ask their doctor a question and then she or he immediately types in the question into their laptop and then reads back the answer. It gives patients the feeling that they just paid a $25 copay to have someone Google something for them," Wolf says.
And that perception, in turn, worries doctors. "Physicians are reluctant to adopt computer-based diagnostic decision aids, in part, due to the fear of losing the respect of patients and colleagues," Wolf says.
Think of the alternatives. Physicians who need to double-check information about medication interactions could sneak out of the treatment room to look the information up without the patient knowing—all the while getting further and further behind on appointments. Or they could always just take a stab in the dark.
I could be wrong, but I can't imagine any physician thinks either of those options is a great idea. And I think we should give physicians a little more credit than that.
Still, if there are some docs out there who really are afraid of looking dumb—who are simply incapable of explaining the benefits of decision support to patients and showing them how it can improve the quality of their care—there is hope on the horizon in the form of smarter and smaller devices that will allow access to EMRs embedded with evidence-based best practices.
"Patients won't even be able to tell whether their doctor is using a computer in their diagnostic decision or not," Wolf says. "In that way, it will become more like the auto-pilot used on commercial planes. When we fly, we do not see what is happening in the cockpit, so we don't mind that computers are actually doing most of the flying."
Eventually, clinicians won't have a choice about using evidence-based medicine and decision support in the exam room. Payers, in particular, will demand it.
"It's too late now to say 'if we should have technology.' Evidence-based medicine will not work without technology driving it. It's impossible," says G. Daniel Martich, MD, CMIO at the University of Pittsburgh Medical Center.
"Doctors cannot rely on pulling out the New England Journal of Medicine and reading it and somehow applying that to their patient population. It's not going to work [without full-blown adoption]."
And if some physicians and their egos still can't figure out a way to adapt and adopt? Well, I hope they enjoy their retirement.