I’ve noticed a big push from HMO insurance companies for starting patients on statins. Basically, every patient with diabetes should be on this medication despite their lipid levels or other qualifying conditions, at least in their eyes. Why? Recent evidence in a large-scale study indicates that statins can reduce the risk for death due to cardiac events.
This study is good evidence for prescribing statins in patients with diabetes and why a good portion of my patients with diabetes take these medications. However, this doesn’t apply to every patient, because medicine is not practiced cookbook style but rather with an art of putting evidence-based knowledge into clinical practice. It takes years to learn this skill, and it is not learned in business school.
For example, I recently had an HMO representative reviewing my quality metrics with me and asking why a specific patient was not prescribed a statin. When I explained that the patient refused, I was simply told to prescribe it anyway. However, informed consent must always take precedence, and patients are allowed to decide what medical therapies they chose to undergo, despite whether it represents best practices. The representative explained to me what I can say to convince the patient to take it. I explained what patient-centered care means and why patient choice matters. The representative didn’t seem to get it or even care. For them, they needed to check the box that this work was done. It was left unchecked.
In other instances, patients were not given prescriptions for statins because they had a bad reaction to one in the past. I was told to try a different one. There are other classes of lipid lowering medications, and I don’t see the reason to change one that is working well and which the patient is tolerating to try one that may make them very sick. Not every patient reads the textbooks and orders their diseases to follow the appropriate clinical pathways.
Medicine has always been an art as well as a science. As doctors, we need to keep up with the evidence as it is rapidly changing. Not keeping up with the latest best practices is not acceptable. However, it is also not appropriate to practice strictly based on clinical guidelines without taking individual patient factors into consideration. That is why the practice of medicine is best left to those who are trained in these skills.
