Close Server: KOPWWW05 | Not logged in

Welcome to Health Care POV | sign in | join
PT and the Greater Good

Guidelines... Efficiency or Mediocrity?

Published August 14, 2012 2:42 PM by Dean Metz

A few weeks back, I posted about how I disliked algorithms and ticky boxes. I felt they took all of the clinical thinking out of the decision-making process. Is it even possible to reduce all medical care into a flow chart?

An article in The New Yorker last week by Atul Gawande, MD, expands on this idea. He compares how medicine works to how the very large, popular and I might add very successful restaurant chain The Cheesecake Factory works. He makes some very good points, particularly about overutilization of services.

The business model employed by this company is remarkable at reducing waste! Waste in the medical field is something universal, including both the USA and the NHS. Dr. Gawande compares the set menus in this restaurant to the guidelines that could be established for certain medical procedures. The UK already has national guidance; the National Institute for Clinical Excellence (NICE).  If you're not familiar with it, have a look around the site. It is interesting.

I was beginning to drink the guidelines Kool-Aid until my colleague told me about her experience at her weekend job at a local hospital. She observed a very elderly gentleman who, following a certain procedure, was being taught how to ambulate with elbow crutches. He was not mastering the skill and appeared to be a danger to himself and others. She interjected, "Why don't you have him use a walking frame? It would be so much safer!" To which the physio replied, "Protocol states all people undergoing (this procedure) must be discharged on crutches!"

So much for clinical thinking!


You are so right.  Everyone is different and therefore need different interventions.  I've lost count of all the times I wanted to bang my head on the wall because some algorithm or policy said something should be done a certain way.  Just because something looks good on paper it doesn't mean it will work for patient care.

Toni August 15, 2012 6:17 PM

leave a comment

To prevent comment spam, please type the code you see below into the code field before submitting your comment. If you cannot read the numbers in the image, reload the page to generate a new one.

Enter the security code below:


About this Blog

    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
  • About Blog and Author

Keep Me Updated