Being a physician and aspiring to treat those we serve within the realm of evidence-based medicine is difficult. One of the things that can feel hard to manage are all the messages from the various medical societies. Though we rely on our specialty societies to aid us distinguishing between valid or inadequate research and informing us about new treatments we should consider, we also experience what can feel like a bombardment of conflicting messages.
As a Hypertension Specialist, I have faced the reality that there are numerous societies, both at the national and international level, that address optimal hypertension levels and opine on the literature and release directives that I am to follow. Frequently I am told how inadequate a job we do in treating blood pressure, almost to the point of shame. The same story is true concerning the treatment of diabetes and glucose control.
As professionals, if we consistently had the patient in the forefront of our minds, we would understand that giving mixed messages to those that treat is markedly worse than just having everyone administer to a level that is not optimal. All paddling in one direction, even using paddles that might have a few holes in them, is preferable than not paddling at all. Mixed messages only confuse, and eventually devalue the important points we are trying to make.
Why do you read such frustration in my words? Recently, eleven collaborating societies released their guidelines concerning the treatment of hypertension. Contemplating the concerns stated above, in an attempt to improve the treatment and control of hypertension, they attempted to rise above the fray and come together in their messaging in order to bring value to both the physician and the patient. Weeks after this publication, two notable primary care societies entirely disagreed with the findings of the collaborators in their own separate ways. Though I am not going to comment on the reasons for the disagreements, as a scientist and pragmatist I do understand the views and points made by each side. However, as a physician working to improve the health of our communities, the entire situation leaves me with pure sorrow and anger.
The sorrow I feel comes from the knowledge that this has caused greater confusion, which means fewer of those in need of help will receive adequate treatment. My anger is based on the reality that our professionals within these societies cannot move past their own biases for the betterment of the whole. Even if the level of treatment was not perfect, (which by the way I am not sure is yet actually known,) our colleagues needed to see the forest for the trees. Furthermore, worsening the situation, this same problematic scenario just played out between societies in regards to the subject of glucose control.
Those who are holding their ground on the ideology that aggressive treatment, though scientifically optimal, have valid concerns that harm and cost are not equally weighted in the conversation. Discerning the degree and validity of the profuse different variables that require consideration is what we are called to wrestle to the ground, not avoid and select sides. As professionals, if we want to elevate ourselves to the level that our patients need us to do, we must come together. Our societies are of paramount importance, and if we are not able to overcome our differences, their relevancy will continue to wane. In the end, patients will suffer the most.