The research team, led by Xinke Liu and Mingqing Wei of Dongzhimen Hospital at Beijing University of Chinese Medicine, together with colleagues including Jing Shi and Jinzhou Tian, conducted a cross-sectional online survey of physicians in January 2025. The final analytic sample comprised 393 physicians drawn from 27 provincial-level regions of China, a geographic spread that gives the results unusually broad coverage for a study of this kind. Rather than simply asking doctors for general impressions, the investigators built a dedicated measurement instrument called the Chinese Medicine Service Quality scale, or CMSQ, which integrates general service-quality principles familiar from mainstream health services research, the philosophy of patient-centered care, and service characteristics that are specific to traditional Chinese medicine, such as herbal decoction services and the evaluation of TCM clinical practice.

The technical rigor of the scale’s validation is a central feature of the study. The six-domain CMSQ demonstrated high internal consistency, with a total Cronbach’s alpha of 0.945 and domain-level alphas ranging from 0.784 to 0.896, values that indicate the items within each domain reliably measure a coherent underlying construct. Confirmatory factor analysis supported the proposed six-factor structure, with a comparative fit index of 0.946, a Tucker-Lewis index of 0.938, a root mean square error of approximation of 0.056, and a standardized root mean square residual of 0.053, all of which fall within conventional thresholds for acceptable model fit. Importantly, the authors also tested measurement invariance and found it supported across hospital levels and hospital types, meaning the instrument measures the same constructs in tertiary referral centers and smaller community institutions alike, a prerequisite for fair comparisons between different tiers of the Chinese health system.

When the scores themselves were examined, a clear pattern emerged. Physicians rated pre-visit responsiveness most favorably, with a domain mean of 4.31 on the scale, followed closely by appointment service accessibility at 4.30. These findings suggest that the front end of the TCM care pathway, the scheduling systems and the way institutions respond to patient inquiries before an appointment, has improved considerably and is now seen by providers as a relative strength. At the other end of the ranking, medication supply services received the lowest domain rating at 3.96, and within that domain, the waiting time for herbal decoctions stood out as the single lowest-rated item in the entire survey, with a mean of 3.61 and a standard deviation of 1.22. For a system in which individually prepared herbal formulas are a cornerstone of treatment, a bottleneck at the decoction stage represents a tangible friction point that patients experience directly.

The subgroup analyses added a geographic and institutional dimension to the picture. Among the physician and institutional characteristics examined, city tier showed the most consistent differences in service-quality ratings, indicating that the level of urban development of a physician’s location is more strongly associated with perceived service quality than factors such as hospital level or hospital type. This pattern echoes well-known disparities in Chinese healthcare more broadly, where megacities concentrate resources, specialist expertise, and modern infrastructure, while smaller cities often struggle to match the same operational standards. The fact that such disparities appear even in physicians’ assessments of their own institutions underscores how deeply structural these differences are.

Perhaps the most consequential analysis concerned the link between service quality and physicians’ willingness to recommend their institutions, a proxy for institutional loyalty and confidence that has parallels in patient recommendation metrics used worldwide. Using ordinal logistic regression with adjustment for covariates, the researchers found that higher recommendation intention was associated with three domains in particular: pre-visit responsiveness, with an adjusted odds ratio of 1.278 and a 95 percent confidence interval of 1.112 to 1.469 and a p value below 0.001; medication supply services, with an adjusted odds ratio of 1.132 and a confidence interval of 1.036 to 1.237 and a p value of 0.006; and TCM practice evaluation, with an adjusted odds ratio of 1.144 and a confidence interval of 1.019 to 1.284 and a p value of 0.022. In plain terms, physicians who felt their institutions were responsive before visits, reliable in supplying medications, and supportive of quality TCM clinical practice were significantly more likely to speak well of those institutions.

To capture the physicians’ own priorities in their own words, the team also collected open-ended suggestions and analyzed 283 substantive responses using latent Dirichlet allocation, a topic-modeling technique that identifies recurring themes in large text corpora without imposing predefined categories. The modeling surfaced three broad clusters of priorities. The first concerned institutional capacity and clinical standardization, reflecting a desire for stronger organizational foundations and more consistent clinical protocols. The second centered on clinical quality, affordability, and the care experience, linking the technical excellence of TCM practice to the financial accessibility of services and the overall patient journey. The third cluster addressed operational management, workforce development, and service accessibility, pointing to the everyday machinery of scheduling, staffing, training, and logistics that determines whether a well-designed service model actually functions in practice.

Taken together, the results sketch a system in which the visible, patient-facing elements of TCM care have advanced faster than the back-office operations that support them. Physicians clearly appreciate improvements in responsiveness and appointment access, but the weak ratings for medication supply and decoction waiting times suggest that the supply chain for herbal medicines, from procurement through preparation to dispensing, has become the limiting factor in perceived service quality. The regression findings reinforce this interpretation, because medication supply services emerged as one of only three domains independently associated with recommendation intention. An institution that cannot reliably deliver the medicines its physicians prescribe undermines both clinical trust and staff morale, regardless of how skilled its practitioners may be.

The study also carries methodological significance for the broader field of complementary and integrative medicine research. Service-quality assessment in TCM has long been hampered by the absence of validated, provider-centered instruments that respect the modality’s distinctive features, from individualized herbal formulations to the integration of traditional diagnostic methods with modern clinical workflows. By demonstrating strong reliability, acceptable confirmatory factor fit, and measurement invariance across institutional strata, the CMSQ offers researchers and administrators a reusable framework that can be deployed in future surveys, quality-improvement programs, and policy evaluations. The authors position it as a preliminary but psychometrically supported, physician-centered instrument, and its open-access publication means that other teams can scrutinize, replicate, and extend the validation work.

The authors, whose work was supported by the Strategic Research and Consulting Project of the Chinese Academy of Engineering and several provincial and national research programs, emphasize that strengthening operational reliability must go hand in hand with enhancing TCM-specific clinical quality and organizational support. The study was approved by the Institutional Review Board of Dongzhimen Hospital and conducted in accordance with the Declaration of Helsinki. As traditional Chinese medicine continues to expand within China’s integrated health system and attracts growing international interest, this survey provides a rare quantitative baseline from the people best placed to judge where the system works and where it strains: the physicians on the front line. Their message is consistent and actionable, celebrating genuine gains in accessibility and responsiveness while demanding focused investment in the medication supply chain, workforce development, and the standardization of clinical practice that will determine whether the next generation of TCM services can match the expectations of both providers and patients.

Subject of Research: Physician-assessed service quality of traditional Chinese medicine healthcare in China

Article Title: Assessing traditional Chinese medicine service quality from physicians’ perspectives: a nationwide survey in China

Article References: Assessing traditional Chinese medicine service quality from physicians’ perspectives: a nationwide survey in China. (n.d.). https://doi.org/10.1186/s12906-026-05549-2

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05549-2

Keywords: traditional Chinese medicine, service quality, physician survey, health services research, CMSQ scale, psychometric validation, medication supply, herbal decoction, patient-centered care, China, ordinal logistic regression, topic modeling

The study was conducted between September 19 and November 4, 2024, using a stratified random sampling method designed to capture the diversity of Chinese clinical practice. Respondents included 48 surgeons, 48 oncologists, and 24 interventionalists or radiotherapists drawn from tier 1, 2, and 3 cities, including Beijing, Shanghai, Guangzhou, Shenzhen, Wuhan, Chengdu, Xiamen, Fuzhou, and Wuxi. All participating hospitals were ranked secondary A or higher within China’s three-tier hospital classification system and each saw more than 100 patients with biliary tract cancer per year. The physicians averaged 16 years of experience in managing advanced disease, and two-thirds held the title of associate chief physician or above.

The clinical picture that emerged is sobering. Physicians estimated that 58.2 percent of patients with advanced biliary tract cancer are initially deemed to have unresectable tumors, meaning surgery, the only potentially curative option, is off the table from the start. Approximately half of patients present with locally advanced disease, while 44.4 percent have metastatic disease. Most respondents, 85.8 percent, indicated that between 30 and 80 percent of their patients have unresectable or metastatic disease at diagnosis, a figure consistent with the disease’s insidious onset. Because early-stage biliary tract cancer produces few or no symptoms, most patients are diagnosed only after the tumor has progressed beyond the reach of the scalpel.

The survey also documented a shift in the disease’s anatomical distribution. Respondents reported that intrahepatic cholangiocarcinoma, which arises within the liver’s bile ducts, was the most common subtype they encountered, accounting for an estimated 39.2 percent of cases, followed by extrahepatic cholangiocarcinoma at 34.6 percent and gallbladder cancer at 26.2 percent. That ordering differs from epidemiological data collected in China between 2008 and 2012, when gallbladder cancer was the most frequently diagnosed subtype. The authors suggest this shift may reflect changing risk factors, including hepatitis B and C infection, obesity, and diabetes, which have driven a rise in intrahepatic tumors.

On the treatment front, the survey found that physicians estimated 77.3 percent of patients with advanced disease receive first-line therapy, while 22.8 percent receive no antitumor treatment at all. Among those who are treated, immunotherapy combined with chemotherapy was the most commonly used first-line modality, selected by 34.2 percent of physicians, followed by chemotherapy alone at 15.8 percent and local-regional combination therapies at 10.8 percent. Yet guidelines from both China and the National Comprehensive Cancer Network recommend immunotherapy plus chemotherapy as the preferred first-line approach, based on phase 3 trials showing that adding durvalumab or pembrolizumab to gemcitabine and cisplatin improves survival compared with chemotherapy alone. Only about a third of surveyed physicians reported following that standard, exposing a substantial implementation gap.

The specific regimens physicians chose reveal further nuances. Gemcitabine plus cisplatin combined with immunotherapy was the most frequently used immunochemotherapy combination, cited by 52.4 percent of respondents, followed by gemcitabine plus oxaliplatin plus immunotherapy at 31.1 percent. The most commonly paired immunotherapy drugs were durvalumab, sintilimab, tislelizumab, and pembrolizumab. Notably, the survey found relatively high use of sintilimab and tislelizumab despite limited evidence supporting their use in biliary tract cancer, suggesting that real-world practice in China deviates from the evidence base in ways that may reflect drug availability and cost rather than clinical trial data. Targeted therapies, such as FGFR and HER2 inhibitors, remained rare in the first-line setting, used in combination with immunotherapy by only 4.2 percent of physicians.

Geography and economics clearly shape treatment decisions. Physicians in tier 1 and tier 2 cities were significantly more likely than those in tier 3 cities to cite patient baseline status and economic considerations as key factors in choosing an immunochemotherapy regimen, differences the authors attribute to uneven distribution of healthcare resources, hospital capacity, and access to novel therapies. The reasons physicians gave for choosing chemotherapy alone included disease characteristics, patient baseline status, economic considerations, and the evidence level of the regimen. The relatively poor tolerability of gemcitabine plus cisplatin, which is associated with nephrotoxicity, nausea, vomiting, and anorexia, may also explain why some clinicians opt for alternative chemotherapy backbones such as GEMOX.

The picture darkens further after first-line treatment fails. Physicians estimated that only 43.8 percent of patients proceed to subsequent therapy after disease progression, with the overwhelming majority of physicians, 94.2 percent, citing the patient’s inability to tolerate existing regimens as the main barrier. Economic constraints and medications falling outside insurance coverage were cited by 65 percent, and patient transfers to other hospitals by 63.3 percent. Among those who do continue treatment, immunotherapy plus chemotherapy was the most common subsequent modality, followed by chemotherapy alone and immunotherapy plus an anti-angiogenic agent. Existing second-line options offer only modest efficacy, underscoring what the survey’s respondents identified as the field’s most pressing unmet needs: a limited selection of treatment regimens, cited by 46.7 percent, and financial barriers to care, cited by 40 percent.

One of the most intriguing findings concerns conversion and downstaging therapy, an approach in which systemic treatment is used to shrink initially unresectable tumors enough to make surgery possible. Roughly 90 percent of surveyed physicians reported experience with this strategy, and most considered patients with technically resectable intrahepatic metastases, large tumors, or vascular invasion to be suitable candidates. Immunotherapy plus chemotherapy and triplet therapy combining immunotherapy, chemotherapy, and an anti-angiogenic agent were viewed as the most credible conversion regimens. However, most physicians estimated the success rate of conversion therapy at below 40 percent, and the authors caution that phase 3 trials are still needed to validate the efficacy and safety of this increasingly popular approach.

Biomarker testing emerged as another critical bottleneck in the pathway to precision medicine. Although 51.7 percent of physicians expressed high willingness to test patients for actionable gene mutations such as IDH1, HER2, and FGFR2, and for immune-related markers including PD-L1 and tumor mutational burden, only 63.3 percent reported that 20 to 50 percent of their patients were actually tested. High testing cost was cited by 93.3 percent of physicians as the main obstacle, and nearly all noted that the positive detection rate for both immune-related markers and actionable mutations was below 20 percent. Even among patients who tested positive, fewer than half, 41.5 percent, went on to receive biomarker-guided medication, primarily because of economic considerations, poor tolerability, and limited guideline support. Overall physician satisfaction with current treatment and management of advanced biliary tract cancer ranged from 6.1 to 7.5 out of 10, with the lowest scores assigned to overall efficacy and drug accessibility. The authors hope their findings will inform future standardization of care in China, where the incidence and mortality of this challenging cancer continue to rise.

Subject of Research: Treatment patterns and physician decision-making for advanced biliary tract cancer in China

Article Title: Patient Characteristics and Treatment Patterns of Advanced Biliary Tract Cancer (BTC): A Chinese Physician Survey

Article References: Qiu, H., Liu, Q., Wang, Z., Chen, W., Tang, W., & Hao, C. (2026). Patient Characteristics and Treatment Patterns of Advanced Biliary Tract Cancer (BTC): A Chinese Physician Survey. Advances in Therapy. https://doi.org/10.1007/s12325-026-03732-y

Image Credits: AI Generated

DOI: 10.1007/s12325-026-03732-y

Keywords: biliary tract cancer, cholangiocarcinoma, immunotherapy, chemotherapy, China, physician survey, biomarker testing, conversion therapy, gemcitabine, cisplatin, healthcare access, treatment guidelines

The scale of the problem makes the details of the survey worth unpacking. Insulin remains the cornerstone of diabetes management when lifestyle modification and oral agents fail to achieve glycaemic targets. Physiologically, the hormone performs two essential tasks: it drives glucose uptake into peripheral tissues such as muscle and fat, and it suppresses the liver’s production of glucose. When these actions are insufficient, chronic hyperglycaemia insidiously damages blood vessels and nerves, setting the stage for cardiovascular disease, nephropathy, retinopathy, neuropathy and premature death. Yet despite well-defined guidelines and decades of evidence, clinicians worldwide delay insulin initiation, a phenomenon researchers call therapeutic inertia. In Lahore, that inertia has now been measured with statistical precision, and the results suggest it is driven by a dense web of patient, physician and health-system factors that reinforce one another.

The research team, led from The University of Lahore, recruited physicians from Internal Medicine, Endocrinology, Gastroenterology and Nephrology at a public sector tertiary hospital. Using a calculated minimum sample of 384, they invited 910 eligible doctors and achieved a remarkable 88.8 percent response rate, with 808 completed questionnaires. The instrument, refined through a pilot study of 20 physicians and content-validated by a panel of 10 endocrinologists, achieved a content validity index of 0.90 and acceptable internal consistency, with Cronbach’s alpha values of 0.73 for the barriers section and 0.79 for the feedback section. Respondents were demographically diverse: 54.3 percent were women, 58.5 percent were aged 41 to 55, and the largest qualification group held the FCPS fellowship, followed by MBBS, MRCP and MRCS credentials. Most participants managed panels in which 11 to 30 percent of patients required insulin.

The barrier data, collected on four-point Likert scales and dichotomised for analysis, paint a picture of systemic strain. Beyond the twin giants of poor education and hypoglycaemia fear, physicians reported complex administration techniques as a barrier in 84.1 percent of cases, inadequate communication in 84 percent, fear of needles in 83 percent, misconceptions about weight gain in 81.5 percent and financial constraints in 81.4 percent. Patient resistance to insulin itself was ubiquitous. These figures resonate strikingly with international comparisons cited by the authors: in Trinidad, primary care physicians flagged needle fear in 98.6 percent of cases; in Saudi Arabia’s Jazan region, 80.5 percent reported injection phobia among patients; and in Nigeria, fear of hypoglycaemia topped the list at 81.3 percent. The consistency across such different health systems suggests that the psychology of insulin refusal is close to universal, even if its intensity varies with local literacy and economic conditions.

Statistical testing revealed that the experience of barriers was not evenly distributed across the medical workforce. Kruskal-Wallis tests with Bonferroni adjustment found highly significant differences by qualification in several domains. Patients’ resistance to insulin, difficulty explaining the differences between short-acting and long-acting formulations, the influence of cultural beliefs, and hesitation rooted in hypoglycaemia fear and regimen complexity all varied significantly across degree holders, with p values below 0.001. Binary logistic regression added a demographic dimension: male physicians were significantly more likely than female colleagues to report barriers, with an adjusted odds ratio of 1.392. Holders of the MRCP qualification faced elevated odds of 1.657 after adjustment, while physicians with 5 to 10 years of clinical experience were markedly less likely to report barriers than those with fewer than 5 years, with an adjusted odds ratio of 0.588. The authors caution that the reasons underlying the gender difference remain unclear and may reflect differences in clinical experience or practice patterns rather than any intrinsic factor.

The experience gradient deserves particular attention. That mid-career physicians encounter fewer obstacles than their juniors suggests a learnable skill set: the counselling techniques, cultural fluency and regimen-management strategies that accumulate with practice. Conversely, the finding that MRCP holders reported more barriers may reflect the complexity of the patients they manage or differing thresholds for perceiving problems. Either way, the authors argue, the pattern points toward targeted professional development rather than one-size-fits-all training. In a country where literacy rates lag behind those of many comparison nations, the dominance of patient education as the leading barrier, reported by 85.8 percent of respondents, takes on added weight. A parallel study from Singapore found that educational level was significantly associated with patients’ willingness to accept insulin, and the Lahore data are consistent with that relationship operating at population scale.

Perhaps the most actionable portion of the study is the physicians’ own prescription for reform. When asked what support was lacking in helping patients understand insulin therapy, the most common answer, endorsed with highly significant differences across qualification groups, was access to diabetes educators. For improving adherence, regular follow-up appointments dominated, and for sustaining patient responses over time, regular follow-up and support was the leading recommendation, chosen by 156 FCPS holders and 105 MRCP holders. On communication, an overwhelming majority across all credential groups selected a combined approach: written instructions, verbal counselling and shared decision-making. When asked how to improve the prescribing process itself, most favoured an all-of-the-above package of streamlined electronic prescribing systems, better patient education resources, improved access to formulary information and closer collaboration with diabetes specialists.

These recommendations align with a growing evidence base. A 2025 systematic review by Aslam and colleagues found that behavioural intervention programmes incorporating patient education, counselling and structured follow-up are effective in preventing and managing diabetes in adults. Pakistan’s rapidly expanding telecommunications infrastructure offers a plausible delivery channel for such programmes, potentially extending education and follow-up beyond hospital walls. Meanwhile, screening initiatives such as the Risk Assessment of Pakistani Individuals for Diabetes aim to identify high-risk individuals before complications develop. The survey’s authors also situate their findings within the broader literature on therapeutic inertia, which attributes roughly 20 percent of clinical delay to health-system factors, including medication cost, resource limits, discontinuity of care and workforce overload, and about 30 percent to patient-related factors such as injection phobia, fear of weight gain and low health literacy.

The study is not without limitations, and the authors are candid about them. Convenience sampling at a single urban tertiary hospital limits generalizability, particularly to rural settings where the majority of Pakistan’s population receives care. Self-reported data carry the risk of recall and social desirability bias. The inclusion of an all-of-the-above response category may have introduced overlap in the chi-square analyses, and the regression models did not formally assess multicollinearity or clustering by department. Crucially, because only physicians were surveyed, the barriers documented are physician perceptions, which may not fully mirror patients’ lived experience. The cross-sectional design identifies associations but cannot establish causation, and the interventions physicians recommended were not tested within the study itself.

Even with those caveats, the research delivers a clear message at a moment when Pakistan’s diabetes epidemic is accelerating. Insulin works; the obstacle is everything surrounding it. The Lahore survey transforms anecdote into quantified evidence, showing that the path to better glycaemic control runs through diabetes educator access, structured follow-up, culturally attuned communication and financial support, tailored to the experience level and professional background of the prescriber. Future intervention-based studies, the authors conclude, must now test whether these physician-endorsed strategies actually reduce barriers and improve outcomes. For a country where one in four urban adults lives with diabetes, the cost of therapeutic inertia is measured not in percentages but in amputations, blindness and lost years of life. What 808 physicians have described is, in effect, a map of where the system is failing, and a first draft of how to fix it.

Subject of Research: Barriers to insulin prescribing and physician-recommended interventions in diabetes care in Lahore, Pakistan

Article Title: Insulin Prescribing Challenges and Physician‐Suggested Interventions: Evidence From a Tertiary Care Hospital in Lahore, Pakistan

Article References: Aamir, M., Nafeesa, B., Aslam, A., Ghulam Mustafa, A., Elahi, M., Elahi, A., Barkat, K., Ashraf, M. U., Wahab, M. S. A., & Akhtar, S. S. (2026). Insulin Prescribing Challenges and Physician‐Suggested Interventions: Evidence From a Tertiary Care Hospital in Lahore, Pakistan. Endocrinology, Diabetes & Metabolism, 9(5), Article e70337. https://doi.org/10.1002/edm2.70337

Image Credits: AI Generated

DOI: 10.1002/edm2.70337

Keywords: insulin therapy, type 2 diabetes, Pakistan, therapeutic inertia, patient education, hypoglycaemia, physician survey, diabetes educators, cross-sectional study, tertiary care, medication adherence, health systems

The scale of the question is enormous. Between 50 and 72 percent of hospitalized patients carry a hypertension diagnosis, and roughly three-quarters experience at least one elevated blood pressure reading during their stay. Acute, symptomatic spikes that cause end-organ damage, known as hypertensive emergencies, demand rapid, high-intensity treatment. But for readings that fall well short of emergency territory and produce no symptoms, the evidence for intervening is remarkably thin, and what observational data exist point in a troubling direction: intensifying antihypertensive medications in the hospital may actually harm patients.

Those signals of harm are not subtle. In a propensity-matched cohort study, hospitalized patients who received antihypertensive medication on an as-needed basis had 24 percent higher odds of acute kidney injury, more than eight times the odds of ischemic stroke, and more than triple the odds of inpatient mortality. Intravenous antihypertensives, in particular, have been linked to prolonged hospital stays, while even oral intensification has been associated with kidney and myocardial injury. Worse, treating elevated blood pressure in the hospital does not appear to improve long-term blood pressure control and may raise the risk of adverse outcomes in the 30 days after discharge.

Recognizing this uncertainty, the American Heart Association issued a Scientific Statement in May 2024 concluding that the risk-benefit ratio of prescribing antihypertensives for asymptomatic elevated inpatient readings is unclear. Blood pressure can rise transiently because of pain, nausea, temperature, or stress, and in those cases the underlying cause, not the number on the monitor, is the appropriate target. But at some threshold, presumably, treatment becomes worthwhile. Where that threshold lies has never been established, which is precisely why a team led by Elizabeth R. Pfoh of the Cleveland Clinic set out to map what physicians actually think.

Between February and October 2024, the researchers emailed anonymous surveys to hospitalists at five academic medical centers: the Cleveland Clinic, Johns Hopkins School of Medicine, the University of Utah School of Medicine, the University of Nebraska Medical Center, and the University of Wisconsin-Madison. They defined elevated blood pressure as readings between 140/90 and 210/120 mmHg without symptoms of hypertensive emergency, deliberately excluding crises from the picture. Of 397 potential respondents, 166 physicians replied, an overall response rate of 42 percent that ranged from 24 to 64 percent across sites. Because the survey straddled the release of the AHA statement, the team also ran a sensitivity analysis comparing sites surveyed before and after May 2024.

The headline finding was a near-even split of professional opinion. When asked whether it is important to treat patients with an elevated blood pressure, 27 percent of hospitalists agreed while 47 percent disagreed, and the remaining quarter were neutral. On average, respondents leaned neutral overall, with a mean score of 3.3 on a five-point scale, but that average concealed a polarized profession: 8 percent strongly agreed treatment was warranted, 19 percent agreed, 30 percent disagreed, and 17 percent strongly disagreed. These attitudes were remarkably consistent across all five institutions, suggesting the divide is not a local quirk but a national pattern.

When it came to numbers, physicians converged loosely around a threshold but disagreed on the details. The median systolic trigger for intensifying medication was 170 to 179 mmHg, yet 38 percent of physicians said they would intensify below 169 mmHg, while 24 percent would hold off until readings reached at least 180 to 189 mmHg. Patience, however, was nearly universal: 79 percent of physicians would wait at least 12 hours before acting on an elevated reading. Patient characteristics mattered even more than the raw numbers. Physicians reported being more likely to treat patients with a history of heart failure (73 percent), stroke (73 percent), myocardial infarction (64 percent), or coronary disease (57 percent), and markedly less likely to treat patients whose elevated readings plausibly stemmed from withdrawal symptoms (81 percent less likely), pain (79 percent), fall risk (77 percent), substance use (61 percent), or nausea (53 percent).

Perhaps the most provocative finding concerned who, in practice, drives treatment. Sixty percent of physicians agreed that treatment is driven by nurses calling physicians, and an overwhelming 89 percent agreed they would prefer not to be contacted by a nurse about an asymptomatic systolic reading below 170 mmHg. Physicians who were least inclined to treat agreed most strongly that nursing calls were pushing them to prescribe, and they expressed the strongest preference for silence below both 170 and even 200 mmHg. The free-text responses laid bare the mechanism: repeated nursing calls create pressure to do something, and for many physicians, the perceived risk of prescribing feels smaller than the discomfort of ignoring an alarm. The AHA’s own framework, which urges hospitals to modify the culture of unnecessary treatment cascades, including default nurse-notification orders, appears aimed squarely at this dynamic.

Qualitative analysis of 133 open-ended responses revealed three broad rationales. Some physicians rejected routine treatment outright, with comments such as increasing medications without symptoms or clear indications puts the patient at higher risk for damage than benefit. Others would treat only when readings remained persistently elevated, for example beyond 24 hours, without another explanation. A third group would act only at very high values, though what counted as very high ranged from above 170 to over 200 mmHg. Underlying it all were two cross-cutting concerns: patient-specific conditions such as heart failure, and process worries such as poor outpatient follow-up after discharge. Meanwhile, only about a quarter of physicians felt there was clear guidance on when to prescribe, and 79 percent strongly disagreed that intravenous medication should ever be used for asymptomatic elevations, a view that hardened further among sites surveyed after the AHA statement.

The survey’s limitations are worth noting. It captured only academic medical centers in five states, response rates were moderate, and anonymity precluded comparisons between responders and non-responders, raising the possibility that physicians with strong opinions were more likely to reply. It is also possible that respondents imagined intensification as a permanent regimen change rather than a single dose, which could have shaped their answers. Still, the picture that emerges is of a profession practicing without a map. A 2024 systematic review found no guidelines at all for asymptomatic elevated inpatient blood pressure, only ten for hypertensive urgencies and eleven for emergencies. Compared with a 2010 survey in which 80 percent of residents called inpatient blood pressure control a high priority, the finding that just 27 percent of today’s hospitalists agree treatment is important suggests opinion has shifted as evidence of harm has accumulated. The authors conclude that randomized trial evidence is urgently needed to inform evidence-based guidelines, which in turn could reduce the wide practice variation that currently governs one of the most common decisions in hospital medicine. Until then, the most defensible approach, the researchers suggest, is the one the evidence already supports: treat the pain, the nausea, the stress, and the underlying illness, and let a truly asymptomatic number wait.

Subject of Research: Hospitalist attitudes toward treating asymptomatic elevated blood pressure readings in hospitalized patients

Article Title: Physicians’ Beliefs About Treating Asymptomatic Elevated Blood Pressure Readings Among Hospitalized Patients

Article References: Pfoh, E. R., Harris, C. M., Singh, M., Pappas, M. A., Ellenbogen, M. I., Shiffermiller, J., Kaiksow, F. A. A., Vaughn, V. M., & Rothberg, M. B. (2026). Physicians’ Beliefs About Treating Asymptomatic Elevated Blood Pressure Readings Among Hospitalized Patients. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10708-9

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10708-9

Keywords: hypertension, hospitalized patients, hospital medicine, antihypertensive medication, blood pressure, American Heart Association, inpatient care, physician survey, overtreatment, clinical guidelines, nursing calls, patient safety