dr Nancy Reau on educating providers about liver disease guidelines

Discussing survey results that show providers have different levels of awareness and understanding of chronic liver disease guidelines, Nancy Reau, MD, Division Chief of Hepatology at Rush University Medical Center, shares how they can improve their understanding.


How were providers asked if they were aware of the liver disease guidelines?

I haven’t specifically answered the question myself, but the build is usually something like “Are you aware that there are guidelines for this?” If the answer was no, well, then it kind of stops. But if the answer was yes, it might prompt you to say, “Well, what guidelines do you know?” I think it’s really different being asked that on a questionnaire than when you have a difficult patient in front of you and you’re like, “Oh wow, I’m going to go to UpToDate and read about it because I don’t know the answer here,” and then UpToDate says, “30% of the time you should do this because the guidelines suggest this is evidence-based medicine.”

It is worrying that a practitioner who feels comfortable caring for a patient with liver disease is unable to identify a guideline or even the academic institution producing the guideline. But that’s not the only management tool available to clinicians. The survey did not ask, “If you don’t know a policy, what would you consider your point of contact?” When it comes to calling a friend next door, that could be problematic. If it comes down to going to UpToDate or looking at Medscape or something, maybe they would get more reliable information.

What should be done to educate vendors about these policies?

The training of doctors or providers is really complicated. We know that if we just email someone something, or you email someone something, it takes the effort to read it and then keep it. If we haven’t highlighted aspects and if it doesn’t feel applicable to the population we care for, and haven’t given us quizzes that show we’ve drawn our medical knowledge from what we read, then maybe not so useful.

I think part of provider education is a bit like patient education. If your patient or caregiver believes that what you are teaching them is important, they will be more inclined to pay attention to and apply it to the patient who comes next. Part of it is simply disease awareness. Make sure anyone who works in a doctor’s office, regardless of specialty, knows that up to 30% to 40% of the patients they see can have concomitant liver disease, even if they come in because of diabetes or diabetes . I’m coming back for a sore throat. This patient may have other comorbid conditions, one of which is liver disease, that he should identify.

If they understand the number of people with liver disease, they’ll be more likely to get that little mailer or that little highlight that says, “Would you like to read this?” This is an educational article about a liver problem.” You might say, “Oh yeah, I need to read this because it’s important to the patients I care for.”


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