Monday, November 14, 2011

Do protocols and guidelines really offer safer and better medicine?

The instruments were indicating to the two co-pilots at the controls of the Airbus that they needed to pull back on the stick.

They held back on the stick for 54 seconds.

This is the position they were in when the Air France jet plunged into the cold water of the Atlantic killing everyone on board.

The fix?

Recognizing that a protocol or guideline might be giving them wrong instructions, seeing that there might be a stall occurring and the airplane was falling out of the sky -- by applying basic airmanship learned during the early hours of learning to fly -- push forward on the stick, gain airspeed, and fly the airplane out of the stall.

So does this happen in medicine? Are we putting patients in the ground by following protocols and not practicing medicine?

Certainly, protocols have revolutionized patient safety in hospital settings. From central line infections, ICU ventilator management, antibiotic use in surgery, suicide prevention with ER counseling -- there are too many to list.

And these successes have lead to a plethora of committee created guidelines for care and protocols. A physician recently spoke at the American Medical Association meeting that one of the largest and most well respected hospitals in the country now has a protocol and guideline for a Whipple procedure!

This is a complex surgical procedure relating to bowel and pancreas resection and the protocol covers the entire hospital stay. Can a committee really dictate all of the ins and outs of a hospital stay of 10 to 14 days duration?

The protocol discussion has also become a huge issue in the mid-level provider debate. When individuals are attempting to practice medicine without the complete training of a physician, nothing is better than a set of rules to follow. And for visits like well child visits and hypertension management -- these work very well.

But can you really develop protocols and guidelines for complex medical procedures or illnesses?

Or more importantly, what parts of your own healthcare would you want managed with a protocol?

I know that if I'm really sick I want a pilot at the controls that can recognize that this time the protocol doesn't apply.

Because at some point in my life my body will be in the situation of flying out of La Guardia, hitting a flock of geese, and having to be hand flown without power into the Hudson River.

They don't make protocols for patients like me.

- Posted using BlogPress from my iPad

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