The Problem with Protocols

Back when I was in medical school, the university hospital developed a systematic protocol for treating a patient experiencing a heart attack.  Now, over 20 years later, such protocols are standard for the diagnosis and treatment of a wide variety of medical conditions. Unfortunately, we can lose sight of the individual amidst these regimented rules and regulations.

Now don’t get me wrong – I have always been a fan of policies and protocols.  After all, once I determine the best treatment for a patient, shouldn’t I offer the same high level of care to all of my patients?  Here are some other benefits:

• Consistent care among different healthcare providers.
• Reduced human error (e.g. reminder to order an antibiotic or blood clot prevention measure).
• Improved documentation.
• Time savings through use of checkboxes or simple mouse clicks.

Like all habits, some are good, and some are bad.  A robot-like response will lead to overlooking the “exception-to-the-rule”.  Reasons include the following:

• More focus on documentation than patient care.
• More reliance on a protocol than common sense.
• Administrative hurdles when deviation from a protocol is deemed necessary.
• An increasing abundance of protocols that can be difficult to manage.
• Loss of individualized care.

In an ideal world, we would have a balance of streamlined protocols and medical judgment.  With increased pressures from governmental and other regulatory agencies, that world just does not seem in sight.  Of course, no amount of written algorithms can replace medical training and experience.