You may have noticed the term “cookbook medicine” making its way through the healthcare blogosphere lately. And no, it has nothing to do with Julia Child’s finest hospital food recipes. It refers to practicing medicine by solely adhering to specific procedures and protocols.
Still in its infancy, hospital administrators trying to implement this highly standardized model of care are facing heavy resistance from physicians.
“This is a very hot topic in the medical community,” said Dr. Al Fisk, Chief Medical Officer of the physician-owned Everett Clinic to a reporter from Modern Physician. “For sure, there is always a fair amount of pushback.”
Advocates like Fisk claim the standardization of healthcare can save lives, time and money. But critics assert it can make doctors lazy and lead to dangerous misdiagnoses.
Today on Power Your Practice we weigh the benefits against the hazards of standardized medicine.
The Benefits
Plenty of evidence exists showing that in healthcare, as in any industry for that matter, standardizing sectors, processes, and people’s functions reduces mistakes. In healthcare, this can translate into better patient treatment.
According to Fisk, Everett Clinic has decreased the frequency of MRI and CT scans by 30% to 40% by building standardized imaging protocols into its EHR. The application uses boxes that physicians must check off to establish whether a patient meets the requirements to order a scan. If the criteria are not met, the EHR stops the scan order.
In addition to saving time and money, Fisk said the reduction in MRI and CT scans has reduced patients’ unnecessary exposure to radiation and has led to safer care.
But in order for physicians and staff to accept standardized best practices, the process has to be transparent. The key to standardization is getting the people affected by protocols involved in the creation of standards. This creates a sense of ownership in the process and leads to better results.
The Hazards
However, the one size fits all approach shouldn’t apply to all aspects of patient care.
While efficiency is important, the practice of algorithmic medicine doesn’t necessarily lead to better outcomes. In fact, it can lead to missed symptoms, misdiagnoses, and unnecessary tests.
Running unwarranted tests on patients who don’t have accompanying symptoms is a waste of time and resources, and can be potentially harmful. Yet, many physicians are quick to send patients to the lab just to move them through the emergency room.
If you are unable to justify tests like CT scans to patients, you may want to consider why you ordered them in the first place. Maybe you’ve unintentionally entered into an algorithmic form of practice and are reflexively inputting orders.
The takeaway from both sides of the debate is physicians should always remember to practice medicine thoughtfully and not mechanically. Although in certain situations standardization may be the best and most efficient manner of practice management, when facing patients, it’s best to focus on their individual symptoms instead of lumping them into a category.
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