The Gold Standard
by Timmermans and Berg depicts standardization in health care, its importance,
the history and the nuances of the practice. I think that the book approaches
standardization from two different perspectives. There is standardization out
of practical necessity and the other comes from regulating patient-doctor
interaction or diagnoses. There were basic benefits of bringing hospitals and
doctors up to a certain norm. The change that occurred in hospitals in the US
during the twentieth century was absolutely critical. It was important for
hospitals to have a central system, organized patient records, a standard of
cleanliness and a standard of doctor accountability. It places the focus back
on the patients who are indeed the most important aspect of treatment. However,
I think Timmermans and Berg correctly point out that however important the
implementation of standards is, that this process can also be political.
I am concerned with the point brought up in the book about
the attempt to turn the art of medicine into a science and the push of money
into more academic medicine. I agree that academic aspects of medicine help
discover new treatments and ways for doctors to approach medical situations,
but I also think that no administrator can make the process of doctoring into
one basic set of rules. I was troubled to read that certain medical decisions
or tests that a patient could receive have already been predetermined by a
committee hoping to set a standard for specific types of patient care. The
standardization through evidence-based guidelines is a good idea but can at
times be problematic. The example
used in the book about the decision to cut down on ultrasounds given to
pregnant women because it may not find anomalies and the decision made to stop
doing herpes screening for pregnant women makes sense statistically but I feel
that these treatments may be necessary for some women. Standardizing basic
procedure may save money but I think it should be up to a doctor’s and
patient’s discretion to decide what tests are superfluous rather than a
beurocratic advisory board. Standardization has very practical uses, but if
this moves into all medical practices it could end up hurting the same patients
it tried to save through the process.
After reading this book I had mixed feelings about standardization. Like you, I recognize the merit of standardizing test results, and the administrative part of medicine, however I definitely agree with your point about the dangers of standardizing the diagnostic process and the treatment plans of patients through evidence-based guidelines. I don't believe that a standard way of treating or diagnosing could ever truly replace the value in a doctor's intuition and a patient's preferences. I also think that there are other dangers to the patients. A few years ago there was talk of raising the standard age women should get their first mammogram. I believe this change in standards would have potentially devastating effects. Yes it is true that most women who get breast cancer are generally middle age and older, however the importance of early detection far out ways the cost in the actual test. By standardizing this potentially lifesaving test, insurance companies may not pay for a mammogram for a women under the "standard age" and therefore many could be put at risk.
ReplyDeleteI agree with both simone's and jessica's points in that need for guidelines is nonexistent when the solution can be found in the intuition of the doctor. Standardization may save money and time, but it leaves out many outlying possibilities between diseases and treatment options. I also liked jessica's last point. The desire to save money by increasing the standard age at which breast cancer is screened for may put those few outlyers at risk for unexpected cancer. Aren't the lives of dozens worth the price of a few million extra dollars spent on our healthcare system. And who should have the right to make that decision? I know who. Do you?
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