Dr. Nancy Reau on educating providers on liver disease guidelines

Discussing survey results that show providers have differing knowledge and understanding of chronic liver disease guidelines, Nancy Reau, MD, section chief of hepatology at Rush University Medical Center, discusses how to improve your understanding.


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

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

It is worrisome that a physician who is comfortable caring for a patient with liver disease cannot label a guideline or even the academic body that produces the guideline. But that’s not the only management tool doctors have. The survey did not ask, “If you don’t know a guideline, what would you consider your go-to resource?” If it’s calling a friend next door, that could be problematic. If it’s to go to UpToDate or search Medscape or something like that, maybe they’ll get more reliable information.

What should be done to educate providers about these guidelines?

The education of doctors or providers is really complicated. We know that if we just mail something to someone or you email something to someone, it takes the effort to read it and then retain it. If we didn’t make points, and if it didn’t feel applicable to the population we’re caring for, and we weren’t asked probing questions that show we got our medical knowledge from what we read, it might not be as helpful.

I think part of provider education is a bit like patient education. If your patient or provider believes that what you are teaching them is important, they will be more inclined to pay attention and apply it to the next patient. Part of that is just disease awareness. Making sure that someone who is in a medical practice, regardless of their specialty, knows that as many as 30% to 40% of the patients they see may have concomitant liver disease, even if they are admitted for diabetes or returning for strep throat. That patient could have other comorbid conditions, one of which is a liver problem, which they should recognize.

If they understand the volume of people with liver disease, they’ll be more likely to, when you get that little banner ad or little highlight that says, “Would you like to read this? This is an educational article about a liver problem.” .” They may say, “Oh yeah, I need to read this because it’s important to the patients I’m caring for.”

Leave a Comment