While endocrinologists will certainly be more knowledgeable and confident in managing diabetic patients in the hospital using insulin, a certain level of confidence and knowledge is to be expected from non-endocrinologists. In an interesting featured poster presentation this morning, Dr. Jessica Abramowitz talked about “High Confidence and Low Knowledge: A Dangerous Intersection.”
A 13-question survey was administered to internal medicine house staff and attending physicians. Dr. Abramowitz showed that the doctors felt confident in prescribing insulin and yet a significant number either continued oral agents or added insulin on top of oral agents instead to shifting to basal bolus regimen.
What I found particularly surprising (gasp!) was when the doctors were asked to correctly identify the pharmacodynamic profiles of different insulins, most of them got it wrong!
Dr. Abramowitz concluded by saying (and this I agree with totally!), that this is a patient safety issue. The study is part of a quality improvement initiative in the hospital.
I passed by the poster at the Endo EXPO and said “Hi” to Dr. Abramowitz! It was interesting that her poster had a QR code (appeals to my inner techno geek) that links to the survey questionnaire. You can see the QR code at the bottom left of the poster.
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Internists certainly need to know about insulin. They are the primary AP most of the time rather than endocrinologists. In many of the PCP Accredited hospitals, endocrinologists routinely teach resident trainees about practical insulin use. And we have always trained them year on year. The problem in the Philippines is not so much that we do not shift to insulin when patients are admitted. Most doctors would but many still use sliding scale with a lot of confidence as if it is standard of care. This as well is dangerous.