Is Your Doctor Out of Date?
A shocking number of physicians are clueless about a number of basic moves that could save your life. Read on to find out how to protect yourself and your family.
High Blood Pressure
The mistake your doctor may be making: Recommending lifestyle changes alone when you need medication.
Scientific evidence shows it’s safe to try to bring down mildly elevated blood pressure by eating a healthy, low-fat, low-salt diet and exercising. But if your readings are beyond what’s considered “mildly elevated” or if you’re in a high-risk group for cardiovascular disease, the advice is unequivocal: Your doctor should be prescribing medication, because uncontrolled high blood pressure puts you at risk for a deadly heart attack or stroke. Guidelines that made this medication recommendation clear were crafted in 1999 by a panel of more than 50 specialists across the country for the Canadian Hypertension Education Program (CHEP) and are updated yearly.
Yet according to Statistics Canada, one third of Canadian adults with hypertension are not properly treated and their conditions are not adequately controlled. Almost half of these people are taking high-blood pressure medication that isn’ t controlling their conditions, and the rest are either not being treated or don’t even realize they have hypertension. “Canada is doing better than anywhere else in the world at controlling hypertension, but we could improve further,” notes Dr. Sheldon Tobe of Sunnybrook Health Sciences Centre in Toronto. Tobe chairs the CHEP’s task force on evidence-based recommendations. “Putting together guidelines takes a huge amount of effort,” he says, “but we need to invest an equal amount of effort into implementation. If it’s just pages of deeply scientiﬁc jargon in some journal, it’s not easily accessible.”
The right move:
According to Hypertension Canada, if your blood pressure is 160/100 or higher, or if it’s 140/90 or higher and you also have diabetes, heart disease or another risk factor for stroke or heart attack, you should almost certainly be on a prescription antihypertensive. And if one medication doesn’t bring your readings into your target range, you should be on more than one.
The mistake your doctor may be making: Not advising you to get your yearly flu shot.
Vaccination guidelines are set by the National Advisory Committee on Immunization, a group stocked with experts and endorsed by the likes of The College of Family Physicians of Canada and the Canadian Medical Association. One key recommendation: Most people should be vaccinated against the ﬂu every year, especially if they provide child care to babies, are older than 65, live in a nursing home, or live or work with anyone who has a chronic medical condition such as heart disease or cancer. Even if a person is healthy, it’s a good idea to get the ﬂu shot: Research shows that up to 90 percent of those who are vaccinated don’t get the ﬂu, and that getting the shot can reduce hospitalizations of those at high risk for ﬂu-related complications (such as people with diabetes) by 40 percent.
Yet studies show that hordes of people who should be getting the flu shot aren’t getting it. Up to 80 percent of those with medical conditions that put them at high risk for influenza complications, and as many as three quartersof health-care workers don’t get vaccinated every year. “It takes only one health-care worker with the flu to infect 20 or more patients,” says Lang.
The right move:
Nearly everyone should get an annual flu shot. If you’re in a high-risk group, it’s especially important you, your family members and your care providers are immunized.
The mistake your doctor may be making: Treating wheezes instead of preventing them.
Asthma is one of the most common chronic conditions in Canada, affecting more than three million adults and children. But experts know it can be effectively controlled. Numerous studies have shown that daily use of inhaled corticosteroids reduces airway inflammation and cuts the frequency and severity of attacks. Dr. Louis-Philippe Boulet, a lung specialist at Université Laval in Quebec City, who set up an asthma-education program across the province, says avoiding environmental triggers such as cigarette smoke, dust mites and pet dander also keeps asthma symptoms at bay.
With these crucial control measures, you’re more likely to sleep better and participate in regular physical activity, and less likely to miss work or school or to need to make a trip to the ER. Yet the Asthma Society of Canada estimates that 60 percent of Canadians with asthma do not have the condition under control. “You should have minimal or, ideally, no symptoms,” says Boulet. “In the past, the concept was short-term control of symptoms. But if you’re still having frequent attacks, then that approach isn’t enough. Long- term control is the concept now.”
The right move:
If asthma symptoms strike regularly- once or twice a week-your doctors should prescribe an inhaled corticosteroid, Boulet says.
The mistake your doctor may be making: Sending you for scans even though the results may not affect treatment.
MRI rates have skyrocketed across Canada-in Ontario, for instance, 41⁄2 times more MRIs of the spine were performed in 2001 than in 1992, and spinal CT scans went up by 51 percent in the same period. But this doesn’t mean scans have been proven to help in diagnosis and treatment. Toward Optimized Practice, an Alberta program that distributes that province’s clinical-practice guidelines, cautions against routinely using imaging to figure out the cause of back troubles. Basing their recommendations on a large body of evidence, the group’s experts say that for most patients, scans and X-rays aren’t helpful enough to be worth the risk of radiation exposure.
Scans are also likely to reveal arthritis or degenerative disks that aren’t necessarily the source of your pain. “Everybody’s got an abnormality,” says Guyatt. Research shows that trying to ﬁx what the doctor sees on a scan may not ease your aches. “Imaging is very seductive for both doctors and patients, but the beneﬁts are highly questionable.” And it’s not just back pain: Physicians are over-prescribing scans for all kinds of health complaints, Lang says. In 2003-04, diagnostic imaging cost Canadian hospitals $2.3 billion, a huge increase from the $1.6 billion spent just four years earlier. “Emergency doctors are always concerned they’re going to miss something, and they don’t want to be involved in a lawsuit or disciplinary issue,” says Lang.
The right move:
If your health problem is likely to go away on its own, or if your treatment won’t change based on the imaging results, your doctor shouldn’t send you for a scan. Most of the time, back pain can be managed with cold and/or heat packs, exercise, acetaminophen or anti-inﬂammatory medication such as ibuprofen.
The mistake your doctor may be making: Not providing emergency treatment fast enough, skipping important aftercare or missing other critical steps.
For the 70,000 Canadians who will have a heart attack this year, immediate care using proven treatments such as Aspirin, clot-busting drugs or angioplasty could mean the difference between life and death. Yet a number of barriers such as ER overcrowding prevent doctors from always being able to act on time. “These are life-saving interventions that are not being followed,” says Lang. Cardiovascular disease is responsible for about a third of all deaths in Canada. When it comes to a cardiac crisis, we could be handling things better: Canadians are less likely to survive a heart attack than are people in the U.S., Italy, France or Japan. More- over, a York University study found that only 43 percent of heart disease outpatients were referred by their doctors for cardiac rehabilitation, even though it’s been proven to save lives.
The right move:
If you have heart disease, check whether your local hospital has a cardiology department or a cardiologist on staff. If it does, it’s more likely you’ll get the recommended treatments for a heart attack-and in a timely fashion.
The mistake your doctor may be making: Failing to test you for it.
An estimated three million Canadians have diabetes, yet more than half a million of them don’t know it. That’s a big problem because unchecked, diabetes can lead to serious consequences such as leg amputations, kidney disease and blindness. “We have convincing evidence from numerous studies that shows if people have excellent blood- glucose control, the risk of complications is markedly reduced,” says Dr. Ian Blumer, a diabetes specialist in Ajax, Ont., and co-author of Diabetes for Canadians for Dummies.
According to the Canadian Diabetes Association‘s evidence-based clinical- practice guidelines, doctors should keep an eye out for people with high odds of developing the disease- namely those who are overweight or have other diabetes risk factors. But even people without a hint of poor health should be tested regularly after age 40. “If you screen only those who are at high risk, you’re going to miss a truckload of people,” says Blumer, who helped develop the guidelines.
The right move:
If you’re 40 or older, you should be tested for diabetes every three years. You should be screened earlier and more frequently if you have one or more diabetes risk factors such as being over- weight, having a family history of the condition or a personal history of gestational diabetes, or if you have Aboriginal heritage.