Chronic Illness Mismanagement, Clinical Inertia, and How to Get What You Need

You’ve been seeing your doctor regularly for some time now. He’s watching your diabetes, or your blood pressure, or your cholesterol, and you’re taking the medicine he gives you, and getting the blood tests he orders for you. So everything’s fine, right?

No. It’s hard to believe, but many chronic illnesses like high blood pressure, diabetes, heart disease and asthma are not being treated adequately by doctors.1 Yes, the doctor is treating you over 40% of the time, the doctor is not treating you adequately, so that you can avoid early death or disability due to these platforms.1

There’s even a name for this: “clinical inertia– failure of health care providers to initiate or intensify therapy when indicated.”2

There are several reasons for this. Our healthcare system doesn’t pay your doctor any differently if he treats you partially or if he treats you inadequately for your illness. You don’t know enough about how you should be treated, so you can’t complain. Also, there are big problems with how the insurance companies and government insurers pay primary care practitioners for the time they spend with you, so often your doctor feels like he’s doing the best he can with the time he can spend on you.

But that’s not good enough. How are you going to avoid blindness, kidney disease, heart disease and amputations from poorly-controlled diabetes? Or a heart attack from years of having poorly-controlled blood pressure or cholesterol? Maybe you’re one of the almost 55% who gets treated correctly. How are you to know?

You have to learn more about your illnesses. You need to find out what the recommended guidelines are for your condition. You need to know what your lab results, blood pressure or medicines should be, and then compare them with your lab results, blood pressure or medicines.

More than 4 out of every 10 patients are not getting the treatment they should. Here’s what you have to do: you need to use the Internet to find out the guidelines/parameters you should be following for your specific illness. Then if you find that your numbers (for lab tests, or blood pressure for example) are not optimal, take the guidelines you’ve found to your doctor and ask for more medication or other treatment that will bring your numbers into correct control of your condition.

BUT if you feel it would be really awkward to show up with the guidelines, then just go in and ask for what you want. For example, if your blood pressure is 145/90 but guidelines says it should be under 140/90, then just say “I’d like my blood pressure to be under 140/90. What should I take to get it there?” Some doctors are going to have less of a problem with this approach because you’re not challenging their authority or knowledge.

The point is you need to get the right care and you need to think of some way to get it done without offending the doctor.

You only have two choices: leave things like they are and suffer the consequences of complications and earlier death from your chronic disease– or go outside your comfort zone and use whatever measures seem most appropriate to get yoru doctor to help you get your disease adequately controlled.

Clinical Inertia

“Clinical inertia is a major factor that contributes to inadequate chronic disease care in patients with diabetes mellitus, hypertension, dyslipidemias, depression, coronary heart disease, and other conditions. Recent work suggests that clinical inertia related to the management of diabetes, hyper tension and lipid disorders may contribute to up to 80 percent of heart attacks and strokes. Clinical inertia is, therefore, a leading cause of potentially preventable adverse events, disability, death and excess medical care costs.” 3

“Clinical inertia is a significant problem in the treatment of diabetes. Physicians do not appear ot be aware of the ADA guidelines or choose not to follow them.”4

“Our data show that there is not enough time for primary care physicians to deliver the services currently recommended for chronic disease management.”5

Studies, Footnotes and Resources:

  1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press, 2001, pp 1, 13-14, 236, 237
  2. Philips, Lawrence S., William T. Branch, Jr., and Curtiss B. Cook et al. “Clinical Inertia.” Annals of Internal Medicine 135(9) (2001): 825-834.
  3. O’Connor, Patrick J., JoAnn M. Sperl-Hillen, Paul E. Johnson, William A. Rush, and George Blitz. “Clinical Inertia and Outpatient Medical Erros.” In Advances in Patient Safety: From Research to Implementation: Vol. 2, Concepts and Methodology. Kerm Henriksen, James B. Battles, Eric S. Marks, and Davis L. Lewin, eds. Rockville, MD: Agency for Healthcare Research and Quality, February 2005.
  4. Beckley, Elizabeth Thompson. “Cluing In on the Causes of Clinical Inertia.” DOC News 3(8) (2006): 4, quoting Alexander Turchin, MD, MS, of Brigham and Women’s Hospital in Boston.
  5. Ostbye, Truls, Kimberly S.H. HYarnall, Katrina M. Krause, Kathryn I. Pollak, Margaret Gradison, and J. Lloyd Michener. “Is there Time for Management of Patients with Chronic Diseases in Primary Care? Annals of Family Medicine 3(3) (2005): 209-214
April 13, 2023

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