PhotoDoctors tend to be with their advice -- quit smoking, eat less, exercise more and so forth. But for some reason, a study finds they're not as eager to recommend a daily low-dose aspirin for patients who might benefit from it.

That's according to a University of Rochester study of a national sample of more than 3,000 patients. It found that a majority of middle-aged men and women eligible to take aspirin to prevent heart attack and stroke do not recall their doctors ever telling them to do so, 

Published online by the Journal of General Internal Medicine, the finding illustrates a common disconnect between public health guidelines and what occurs in clinical practice. The study is consistent with other research showing that physicians often do not recommend aspirin as prevention therapy to the general population, despite established guidelines by the U.S. Preventative Services Task Force.

Pressed for time?

Several reasons might explain the reluctance, such as competing demands and limited time to properly assess a patient’s eligibility for aspirin, according to lead author Kevin A. Fiscella, M.D., professor of Family Medicine at the UR School of Medicine and Dentistry.

Uncertainty about the benefits of aspirin therapy versus potential harms like bleeding in the digestive tract, also hinder physicians’ decisions, the study said.

Co-author John Bisognano, M.D., director of outpatient cardiology services at UR Medicine, said most physicians can agree on approaches to medical care in immediately life-threatening situations, but have less enthusiasm to quickly embrace preventive guidelines, particularly when they involve wide-ranging interventions for a large segment of the population.

Also, patients can be reluctant to heed advice that conflicts with past practices, Bisognano noted. Despite the USPSTF guidelines for aspirin being published in 2009, for example, the FDA declined to approve the same recommendations as recently as last spring.

“Patients often view changes as an illustration that folks in the medical field can't really make up their minds,” said Bisognano. “Changes can undermine a practitioner's or patient's enthusiasm to immediately endorse new guidelines because they wonder if it will change again in three years.”

But science and medical practice is fluid, he said, and the only way to move the field forward is to continually understand and look for ways to apply the new data and avoid assumptions of the past.

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