Friday, June 01, 2012

Standardization's Downfall

Doctors are an inquisitive bunch.  The diagnostic challenge, new innovations that come our way, and the constant variety of various pathologies we encounter are some of the best parts of what we do. 

But if you want to kill a doctor, make things rote.

Increasingly I see a push toward the checklist, the proscribed, the "clinical pathway" in managing patients.   We are getting incredibly good at making production lines in medicine.  Bring 'em in, get 'em out.  Time and time again. While there are benefits of managing patients with such an approach in terms of health care "efficiencies" and reducing some errors, these checklists, automation, and their associated lack of thought are also inducing higher-than-usual rates of clinical complacency.   Too often we assume, too often we expect, too often we overtest, too often we fail to double check -- after all, it's automated!

And it's not just with clinical care.  The other day, while I had to get a new hospital ID badge, I noticed the subtitle below my name had changed from "Cardiac Electrophysiologist" to "Medical Group."  While I'm sure it's efficient to describe all doctors as "one group of doctors," we lose our identity, our meaning, our purpose for all of these years of training and specialization.  When specialists become groupies, our former multi-colored specialty world is reduced to the drab, grey world of group-think.

Group-think for patients, isn't always the correct-think.  Making things the same, risks making things routine.  Making things routine, risks making them seem boring.  Making things boring, risks inducing complacency.   

Complacency induces errors, too.

So let's keep some variety.  Take the "road less traveled" sometimes.  After all, being an outlier isn't always bad;  rather it's within our normal distribution.



Anonymous said...

Resistance is futile. You will be assimilated.

Anonymous said...

So true! Nicely said!

Anonymous said...

The change in the ID subtitle may cause confusion for the patient. Isn't it better that the patients and/or family members know which specialty they are interacting with as they navigate the already confusing, oftentimes terrifying, hospital experience? I would rather know I'm being treated by a specialist than a generic member of the "Medical Group."