A physician ’s mixed feelings about clinical pathways

As the kids say, it’s complicated. Practicing physicians are seeing an ever increasing list of protocols and pathways coming their way. These arrive in several forms — order sets for medications, guidelines in how to proceed for various conditions, when to do this, when to do that, and when not to do either one. They generally are the product of various committees trying to synthesize what these days we call “best practices.” I have no doubt these aids are useful. They can focus the mind, streamline care and reduce medical costs. They also have the potential to improve care on average. Checklists, one form of the phenomenon, have been shown to make care safer for several things. The model is simple, following what airline pilots do. If you’ve ever glanced to your left as you filed onto an airplane you’ve seen the pilots methodically going over a series of lists as they prepare for takeoff. Nothing is assumed to be correct and functional until it’s been checked. The practice of anesthesiology in particular has been made safer by the concept; everything is checked and confirmed to be ready and in place. Nowadays we even make sure we’ve got the correct patient by checking the identification band on the person’s wrist. Surgeons verify and mark in advance the spot where they’re going to cut. A popular recent book by Atul Gawande is all about medical checklists. Continue reading ... Your patients are rating you online: How to respond. Manage your online r...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Intensive care Source Type: blogs