I am writing in regard to your May 2001 article "Powers of persuasion," which highlighted the efforts of four hospital chief medical officers in reducing errors and improving outcomes (page 22).
Notably, the article's focus was the pragmatic challenge each faced in getting physician support for efforts to adopt guidelines and tools that address the issues of inappropriate variability and patient safety.
Theirs is a monumental challenge. John Eisenberg, M.D., head of the Agency for Healthcare Research and Quality, says it best: "There is sufficient evidence to suggest that most clinicians' practices do not reflect the principles of evidence-based medicine but rather are based on tradition, their most recent experience, what they learned years ago in medical school, or what they heard from their friends. The average physician is said to read scientific journals approximately two hours per week, and most are likely overwhelmed by the volume of material confronting them."
In the IOM report "Crossing the Quality Chasm," eight of the 14 recommendations point to the need for providers and payers to adopt evidence-based medicine as a basis for guideline development. That's the appropriate and logical starting point for every hospital CMO.
Powers of persuasion lacking scientific support fall on deaf ears among physicians whose skepticism about "cookbook medicine" is understandable and whose professionalism argues for dependence on their opinion only. Until and unless guidelines based on evidence-based medicine are implemented by hospital CMOs as the centerpiece of efforts to improve outcomes, reduce patient errors and reduce inappropriate variability in practice patterns, these challenges will continue.
Evidence-based medicine is the starting point for guideline development. Powers of persuasion alone are limited, lacking scientific support for "what works best and why."
President and CEO