Friday, March 31, 2017

Cookbook Medicine

Last month, I discussed an educational campaign to persuade doctors to stop doing things that don’t work. Readers wondered at the fuss. I mean, if something doesn’t work, why not forbid it? If penicillin won’t cure your toe fungus, the pharmacist couldn’t fill your prescription. If you arrived at the radiology suite for a CAT scan of your brain, the technician would inform you that CAT scans for migraine are rarely helpful, so he couldn’t do one.

This will never happen. It’s “cookbook medicine” which everyone agrees is bad. Medicine is a science, doctors emphasize – except when someone tells them to do something they don’t want to do. Then medicine is an art, and everyone knows there are no rules in art.

We know from the movies that the hero never follows the book. That’s for fuddy-duddies.  

Here’s an example. Preparing a patient for surgery is a complicated process. It requires dozens of tests, procedures, and reminders. But no one is perfect; nurses and doctors often forget a few. It turns out that the consequences are disastrous. In one study where some surgeons followed a checklist and others didn’t, the death rate dropped by almost half -- from 1.5% to 0.8% with the checklist. Complications dropped from 11% to 7%. Other studies agree.

As a result some nations and many states passed laws requiring checklists for operations.. Hospitals hand them out. Some surgeons take them seriously. Some ignore them. Some consider them more bureaucratic paperwork; they check the boxes whether or not they’ve obeyed. It turns out that commercial airlines also require an elaborate checklist before taking off. Pilots probably obey more often than surgeons, but, for your peace of mind, don’t Google either topic.  

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