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Celebration Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Oct-12-11 06:45 PM
Original message
New buzzwords 'reduce medicine to economics'
http://medicalxpress.com/news/2011-10-buzzwords-medicine-economics.html


"We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized. Hospitals and clinics should be run like modern factories and archaic terms like doctor, nurse and patient must therefore be replaced with terminology that fits this new order."

The problem, Hartzband and Groopman, note, is that the special knowledge that doctors and nurses possess and use to help patients understand the reason for and remedies to their illness get lost in a system that values prepackaged, off-the-shelf solutions that substitute "evidence-based practice" for "clinical judgment."

...........snip..............

Hartzband and Groopman say the new emphasis on "evidence-based practice" is not really a new phenomenon at all. "Evidence" was routinely presented on daily rounds or clinical conferences where doctors debated numerous research studies.

"But the exercise of clinical judgment, which permitted the assessment of those data and the application of study results to an individual patient, was seen as the acme of professional practice. Now some prominent health policy planners and even physicians contend that clinical care should essentially be a matter of following operating manuals containing preset guidelines, like factory blueprints, written by experts."


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Scuba Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Oct-12-11 06:58 PM
Response to Original message
1. Um, there's a whole lot of data that shows access...
...to "evidence-based medicine" helps physicians and patients.


Physicians would have to read medical journals 30 hours a day to keep up with new knowledge regarding diagnosing and treating patients.

Evidence-based medicine digests that and, with integrated technology, makes this information available to the physician during examination, treatment and decision-making.

Historically, it's been something like 15 years between when a method has been defined as "best practice" and when it is adopted by even 51% of practicing physicians. Systems such as I describe can bring this down to a matter of days.

Finally, many physicians who decry such systems practice their own "cookbook medicine", but the cookbook is what they learned in medical school, perhaps decades earlier.
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HuckleB Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Oct-12-11 07:58 PM
Response to Reply #1
3. Exactly.
Edited on Wed Oct-12-11 08:33 PM by HuckleB
Clinical judgment without knowledge is not good clinical judgment. This piece is also loaded with some serious bizarre rhetoric that is not exactly the language used in health care. It's and odd hit piece, IMO.
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johnd83 Donating Member (190 posts) Send PM | Profile | Ignore Wed Oct-12-11 07:01 PM
Response to Original message
2. This works great unless you get an unusual disease
There is a huge problem for lyme disease patients that "best practice" is useless and leaves sever disabilities because they are denied treatment. Some judgement needs to be left up to the doctor to have freedom to figure out what the heck is going on in unusual cases.
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Scuba Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Oct-12-11 08:39 PM
Response to Reply #2
4. I know a doctor who diagnoses ALL his patients with Rocky Mountain...
...Spotted Fever. All of them.


Yes, physicians should use good judgement. That includes taking advantage of evidence-based medicine, best practices, standard treatment protocols and other such tools.
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johnd83 Donating Member (190 posts) Send PM | Profile | Ignore Wed Oct-12-11 10:34 PM
Response to Reply #4
5. Bad doctor?
Protocols won't save you from a bad doctor. Medicine is not an exact science. It takes a lot of skill to practice effectively. Treating doctors like computers or bureaucrats is not a good solution.
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