Another good article coauthored by Jerome Groopman, New Yorker staff writer and Harvard physician, on the dangers of promoting protocol-based medicine:

…rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials. To that end, a good doctor exercises sound clinical judgment by consulting expert guidelines and assessing ongoing research, but then decides what is quality care for the individual patient. And what is best sometimes deviates from the norms.

David Sackett, a guru in the world of evidence-based medicine, is cited in the article as famously saying that “half of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of your graduation; the trouble is that nobody can tell you which half — so the most important thing to learn is how to learn on your own.”

Science depends upon such a sentiment, and honors the doubter and iconoclast who overturns false paradigms.

We can never replace the individual judgement of good physicians with strict protocols, not in the foreseeable future. Medicine remains more of an art than science and science is driven more by creativity than vise versa. Strict rules on how to practice medicine can force physicians down the wrong path and end up hurting patients.

Filed under: Health Policy