The authors point out that there are also dangers to standardization. They point out there are claims stating procedural standards may restrict doctors and dehumanize health care. When they use evidence based medicine, clinical practice will be based on clinical trials and the creativity in the process will be lost. These concerns remind me of what Jerome Groopman discusses in How Doctors Think. He claims medical students are being taught with an algorithm like method where the questions asked leads to a diagnosis. These questions are typically "yes" or "no" type of questions, which may lead to an incorrect diagnosis. He advocates for the doctor to listen to the patient and avoid asking these "yes" or "no" type questions to make a better diagnosis. There needs to be some stands regarding procedure, like what must be done to declare an operating room is ready to be used, however the treatments patients receive should not be wholly based on clinical trials. While I believe that being familiar with other people's research is important, an effective doctor should be able to mix in research with personal experience instead of valuing one over the other.
Saturday, April 21, 2012
Pros and Cons for Standardization
In The Gold Standard, Stefan Timmermans and Marc Berg show the importance of standardization in health care. It is easy to recognize the benefits gained from the four types of standards. They are interrelated, each kind of standards boosting the effectiveness of the others. The first chapter shows how these different kinds of standards helped improve the health care system. In the past, doctors had sparse notes on their patients. It is beneficial for hospitals to keep records of each patient instead of searching through multiple doctor's notebooks to find the notes. This type of design standard make the system more efficient and effective in the long run. Furthermore, doctors would have to use similar terminology once the patient's records are more systematize so that other doctors will understand the notes. As mentioned in the chapter, through creating these records, we will then have a big picture view allowing us to create performance standards. This is shown through once they started to compile patient records, they can adequately judge a doctor's performance.
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This book definitely hits hard, as it elucidates the complexities to be faced by our generation’s emerging members of the medical and health policy community. I was particularly troubled by the thought of evidence-based trials being used to create a more “efficient” system in medicine. This form of standardization sticks out with great danger, as does any attempt to restrict the specificity and flexibility that is required for the highest quality of personalized medical care. While I do believe that there should be standards of the system, such as a restriction of hours in order to minimize mistakes due to fatigue, I do not think that such standards should be imposed upon procedural and clinical experience (except maybe standards of hygiene and appropriateness of doctor-patient interaction). One of the difficulties required of being a doctor is to be a keen critical thinker and the to have the ability to analyze complex situations and determine the proper steps towards a solution. With the implementation of a standardization of care, the sense of personalization would be greatly lost from medicine.
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