Anyone traveling to unknown places in the car feels less stressed with a navigational system that directs one through the journey. If you make a wrong turn, it “recalculates” to get you going in the correct direction.
Driving from Virginia to Florida, I too felt confidence in “knowing the way” with guidance from my GPS, named “Gypsy” for my roaming treks.
Gypsy sent me on a wild goose chase twice. I knew to stay on the Florida turnpike yet she kept imploring me to exit. Not wanting to ignore her, I exited where she commanded, only to find myself on a slower one-lane road. You see, she had an ulterior motive. She wanted me on the I95.
Gypsy is a machine- a helpful tool to guide me. Yet, it shouldn’t override my own knowledge and intelligence as a human, gleaned from past experience.
Then, it hit me!
This is the same premise as using an EMR system!
While it’s true that physicians can’t know everything with new developments and breakthroughs occurring so rapidly in today’s medical environment, there are tried and true therapies that doctors DO know…and it’s being challenged!
Although doctors make healthcare decisions based on experience and knowledge, they are now compelled to follow guidelines to standardize (and improve?) treatment. Should there be a deviance to guidelines, compensation will decrease and the quality of care will be questioned.
Guidelines- Are they in the Best interest of Patients?
Dr. Howard Beckman, Chief Medical Officer at Focused Medical Analytics, a Rochester, New York-based medical analytics firm, points out “Guidelines are designed to help people make decisions based on evidence, and most physicians are eager to embrace that. But the problem is that the guidelines are becoming rules. Treating guidelines rigidly is reductionist. It assumes that there is a right buy ventolin ventolin evohaler order nebulizer solution answer when often times, it’s not as right as you think. Rigidity encourages physicians to make decisions that aren’t always in the best interest of the patient.”
The Executive director of the Health Policy Research Institute at the University of California in Irvine, Dr. Sheldon Greenfield is in complete agreement and explains it this way:
“A doctor has to have the room to override the guideline; that’s the core issue. Requiring physicians to adhere to an absolute — such as achieving a certain blood pressure — is analogous to a cop ticketing every driver doing 66 mph in a 65-mph zone. Used in such a way, “guidelines can be oppressive. Doctors should not be forced to practice cookbook medicine.”
Dr. Greenfield still feels that guidelines has an important place in the practice of medicine and doctors should use them as tools to achieve higher quality while not wavering from the guidelines as much as possible as we move toward uniformity and greater standardization.
“Doctors have a lot more maneuverability right now than they will in the future,” he says. “They are foolish to resist.”
Are we being led down the wrong path?
Experienced doctors may use the guidelines to confer with, as another opinion or “bedside consultation”. Unfortunately, the younger, less experienced physician may rely solely on the guidelines set by EMRs, medical societies and hospitals without taking into consideration that everyone is different and people don’t always fall within set parameters.
So, will we wind up in medical care the way I did, heeding my GPS? Following a tool that may have it’s own agenda and may be wrong for a specific instance, may lead us astray and go against experiences.
We are heading down a bumpy road indeed!