Standardization

Stefan Timmermans and Marc Berg's The Gold Standard: The Challenge of Evidence-Based Medicine discusses evidence-based medicine, why it came about, and how medical professionals use it. I particularly enjoyed his section about standardization in medicine. When he wrote about the history of medical recording standards, I was reminded of my experience working as an administrative intern with a clinic in Tel Aviv, which provided basic medical care at no cost to people without health insurance. The way they dealt with medical records was very problematic because they had few standardized systems and guidelines set up for opening medical files and storing them after patients had seen the doctor. Because many of the patients were from Eastern Africa and entered the country as asylum seekers, many had no identification and could not write in characters that the staff could understand, we were often unable to locate files from previous visits as names had been misspelled, addresses had been changed, volunteers had filed them in the wrong place, or patients had taken files home after misunderstanding instructions about the files due to the language barrier. This, among other inefficient factors, led to a lot of wasted time and frustration for patients, doctors, and staff. If the clinic had a greater level of standardization including rules about the number of translators employed, and a system for collecting and filing records after each patient saw the doctor, we would have been much more effective in helping patients. While standardization can be problematic, as pointed out by Timmermans and Berg, as well as Groopman, it is necessary in many administrative and organizational aspects of medicine.

I also thought the section in the introduction where the authors talk about Taylorism was particularly interesting in the context of medicine and medical professionals. In their discussion of Taylorism, Timmermans and Berg highlight several studies that were done in the quest for a more efficient workplace. The one that caught my attention was Taylor's observation that in many cases, productivity decreased after laborers work for a certain amount of time, as people grow tired; Therefore, it was more practical to have more people working fewer hours, than to have a small number of laborers working for many hours (19). One would think that this would also be true of doctors. As we discussed after reading Charles Bosk's Forgive and Remember, doctors work brutally long hours and are often sleep deprived, which greatly increases the probability the they will make mistakes. As Bosk points out, these errors can be catastrophic for both patients and doctors. I do not know a great deal about regulations on the number of hours doctors are allowed to work over a given period of time, but I suspect that the number of medical errors, particularly technical, judgmental, would greatly decrease if the number of hours doctors were allowed to work without rest decreased.