Wednesday, September 07, 2011

The problems with guidelines - the elephant in the room

Infertile couples often get upset when their doctor refuses to provide them with the treatment they want. This is especially a problem in places like the UK where the NHS pays for IVF treatment. Because IVF treatment is expensive , doctors need to follow guidelines which have been laid down in order to ensure cost-effective use of limited resources. The one who pays the piper calls the tune !

Because these guidelines are laid down by bureaucrats they're all in black and white, which means the ability of the doctor to make decisions is remarkably curtailed . He has little autonomy and cannot break the guidelines or tailor them for that individual patient's needs.

While this is upsetting for patients , it is very upsetting for doctors as well , because they've been forced to put all round pegs into square holes. It’s no fun to mindlessly apply the same protocol to all patients. All good doctors know that each patient is different , and requires a tailor-made protocol. One size cannot possibly fit all in medicine !

Doctors need to start educating patients that some of these guidelines are issued by faceless bureaucrats and corporate; and that while these guidelines are very effective when they're applied to populations , they can unfortunately be very unkind when applied to individuals.
Sadly , the doctor can't do much about this , given the fact that he operates within a system which places a lot of constraints on his ability to make decisions , even if he makes these in the patient's best interests.

We will all have to pay the price for this loss of autonomy when it is our turn to seek medical care when we fall ill. We have taken away the medical profession’s authority to make decisions in the individual patient’s best interests. When more doctors start practising evidence-based medicine, the bean-counters maybe pleased – but inevitably, some patients will suffer. It’s easy to justify this individual pain by saying it’s for the good of society, but I personally believe this is a big step backwards, because we have succeeded in driving a wedge between the doctor and patient. Instead of focusing on doing what’s best for the patient who is stilling in front of him and asking for help, the doctor is now answerable to too many other masters !

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