The physician's conundrum: Too much information, too little time


Recent articles have drawn attention to two serious physician stressors: (1) the overwhelming volume of rapidly changing medical evidence that physicians are expected to apply to clinical practice and (2) the relentless pressure to see more patients in less time.

Dr. Jerry Avorn, in his New York Times opinion piece, dubbed the information overload as a sort of “Stendhal syndrome,” noting that the dozens of hours a week it would take a physician to read everything necessary to stay current is a “dizzying and impractical prospect.” In response, Dr. Suzanne Koven wrote in her Boston Globe column, In Practice, that the main source of stress for her isn’t the flood of new information, but rather “the pressure I feel to see patients more and more quickly.”

In fact, the two stressors go hand-in-hand. Both result from too little time and too few resources to dedicate to the most essential focus of a physician’s job:  accurately diagnosing and treating patients.

One reason why it takes an average of 17 years for new medical evidence to be incorporated into clinical practice is that a physician would need to read 19 journal articles every day just to keep up with the 2 million scientific articles published annually. Another factor at play is the lack of corresponding guidance to help physicians determine when new findings are significant enough to change clinical practice.

Left to make such decisions in a silo and with little time available already, many will simply use practices that were once current but are no longer.

One way physicians have tried to keep up in recent years is to rely on the Internet. A survey of American Medical Association members showed that 46 percent of doctors frequently used sites like Google and Yahoo to treat, diagnose or care for patients. But consider the outcome when one consults “Dr. Google” with a clinical question: hundreds of relevant and irrelevant search results are returned—often from sources that are not immediately evident or credible—that require clicking and skimming to determine if they are even applicable to the problem at hand. No physician has time for that while a sick patient sits waiting in the exam room.

The answer to these interrelated problems is broader adoption of clinical decision support (CDS) resources that quickly and easily answer clinical questions at the point of care. Numerous studies have validated the impact CDS has had on helping physicians provide better care. As such, CDS resources have become a critical tool in managing the flood of clinical information and empowering physicians to have confidence in the decisions they make to treat patients. To be truly effective, these resources must deliver information that is trust-worthy, easily accessible and presented in a way that delivers the answers physicians need most.

The best CDS resource answers a clinical question with the most relevant information, quickly and succinctly, for easy use at the point of care. That information is original content that has been authored and peer-reviewed by clinical domain experts based on their critical evaluation of the latest medical literature.

The CDS resource should also put new medical evidence through the same rigorous evaluation, with findings that may change the usual clinical practice presented along with specific statements and graded recommendations as to how they should be applied clinically.

Synthesizing existing and new medical evidence into easily digestible information that can be delivered to the point of care with specific, actionable recommendations makes it possible for physicians to avoid Avorn’s “Stendhal Syndrome” in the seemingly incessant flow of new evidence. It also lets them make the most of their limited time with patients by ensuring more clinical questions are answered accurately and quickly to support the best care management decisions.

Stress will remain part of the physician’s dilemma but, such a clinical decision support resource can significantly help ultimately physicians achieve their most important goal:  providing the best care for their patients.

Denise Basow, MD, is vice president/general manager and editor-in-chief of UpToDate, part of Wolters Kluwer Health.