I think this article fits in nicely with our discussions on practice guidelines and performance measures. For me, at least, it is easy to see how practice guidelines and national standards could be both helpful and harmful. The author's point about the algorithm excluding patient history and physical exam demonstrates the issue with following a guideline too strictly, possibly missing other potential conditions. On the other hand, I could see where guidelines might feasibly be helpful, especially having something like a checklist for some diagnoses, etc. I also wonder whether more explicit or more suggestive guidelines might be beneficial. If a more explicit guideline was accurate, then it seems that it could be helpful, assuming that the correct diagnosis was made, but it also seems that this would negatively impact physician autonomy. In this case, more suggestive guidelines might be useful, but depending on context, might open up potential for malpractice suits.
I agree with Lauren that clinical practice guidelines are a double edged sword. While I agree that practice guidelines should exist, their role should be suggestive and informative, not quality measures.
When the practice of medicine becomes governed and measured by algorithms then it is time to replace physicians with computers which follow algorithms better and more efficiently. The problem with this scenario is that computers do not have a right brain, they are all algorithms. That said, anytime a patient fails the algorithm then the computer is left without the ability to solve the problem.
To add further complexity, even if the diagnosis is right and an algorithm might work, there are human factors that may prevent the desired outcome. For instance, behavior plays a large role in medical outcomes. Is there an algorithm for behavior? What if a patient will not or cannot follow the algorithm? Does that mean the provider is providing poor care? What does that imply about the patient?
So while it is true that practice guidelines should exist, they should be guidelines and not quality measures. Also, as far as medical education is concerned, physicians still need to be required to demonstrate the skills necessary to problem solve and to continually improve practice.
I think this article fits in nicely with our discussions on practice guidelines and performance measures. For me, at least, it is easy to see how practice guidelines and national standards could be both helpful and harmful. The author's point about the algorithm excluding patient history and physical exam demonstrates the issue with following a guideline too strictly, possibly missing other potential conditions. On the other hand, I could see where guidelines might feasibly be helpful, especially having something like a checklist for some diagnoses, etc. I also wonder whether more explicit or more suggestive guidelines might be beneficial. If a more explicit guideline was accurate, then it seems that it could be helpful, assuming that the correct diagnosis was made, but it also seems that this would negatively impact physician autonomy. In this case, more suggestive guidelines might be useful, but depending on context, might open up potential for malpractice suits.
ReplyDeleteI agree with Lauren that clinical practice guidelines are a double edged sword. While I agree that practice guidelines should exist, their role should be suggestive and informative, not quality measures.
ReplyDeleteWhen the practice of medicine becomes governed and measured by algorithms then it is time to replace physicians with computers which follow algorithms better and more efficiently. The problem with this scenario is that computers do not have a right brain, they are all algorithms. That said, anytime a patient fails the algorithm then the computer is left without the ability to solve the problem.
To add further complexity, even if the diagnosis is right and an algorithm might work, there are human factors that may prevent the desired outcome. For instance, behavior plays a large role in medical outcomes. Is there an algorithm for behavior? What if a patient will not or cannot follow the algorithm? Does that mean the provider is providing poor care? What does that imply about the patient?
So while it is true that practice guidelines should exist, they should be guidelines and not quality measures. Also, as far as medical education is concerned, physicians still need to be required to demonstrate the skills necessary to problem solve and to continually improve practice.