Why Guidelines suck !
Medicine is becoming a game for bureaucrats, administrators, and accountants. Which is completely appropriate, considering the amount of time, money, and resources spent on it. And its overall importance.
But a constant annoyance to the administrators is that CLINICIANS ( those folks who actually treat patients ) almost never follow recognized guidelines. The reason why can be explained by a young girl and her father walking along the beach, watching starfish.
There are a gazillion starfish stranded on the beach, victims of the receding tide. The young girl keeps picking them up and flinging them back into the water. Her father says "Why do you bother ? It doesn't make that much difference ! You are changing the life on one starfish in a million "
The young girl responds to her father " It matters if you are that one starfish !"
But a constant annoyance to the administrators is that CLINICIANS ( those folks who actually treat patients ) almost never follow recognized guidelines. The reason why can be explained by a young girl and her father walking along the beach, watching starfish.
There are a gazillion starfish stranded on the beach, victims of the receding tide. The young girl keeps picking them up and flinging them back into the water. Her father says "Why do you bother ? It doesn't make that much difference ! You are changing the life on one starfish in a million "
The young girl responds to her father " It matters if you are that one starfish !"
One starfish at a time ....
The statisticians and miscellaneous bean counters look at the millions of starfish when they make their guidelines. And make decisions on what is cost effective and beneficial for the entire population of starfish. Based on economic indicators, local resources, the latest vote of their committee. And sometimes the available medical evidence.
An individual doctor with an individual patient does not think of the gazillions of patients, and the official guidelines. He thinks of the one patient in front of him. Which is a totally different viewpoint than the administrators.
Neither is right or wrong. They just have totally different views of the world.
An individual doctor with an individual patient does not think of the gazillions of patients, and the official guidelines. He thinks of the one patient in front of him. Which is a totally different viewpoint than the administrators.
Neither is right or wrong. They just have totally different views of the world.
Guidelines by the ton....
I have a friend who is a cardiologist, a full professor at the University of British Columbia, and who has been involved in teaching medical students and doctors for over 30 years. He receives approximately 17 Kg of guidelines per year.
I know this because he told me. He weighs the guidelines --- he doesn't ever actually read them. There would be no point. Because there is nothing useful he could learn from them.
The guidelines are a compromise between accountants, politicians, administrators, and ( occasionally ) physicians. What they are NOT is scientific documents. They are usually ways of saving money. And sometimes rough guides for people who are insecure and don't have expert knowledge of what they are doing.
But true experts almost never follow guidelines. The reason is because the guidelines are not directed towards individual patients.
I know this because he told me. He weighs the guidelines --- he doesn't ever actually read them. There would be no point. Because there is nothing useful he could learn from them.
The guidelines are a compromise between accountants, politicians, administrators, and ( occasionally ) physicians. What they are NOT is scientific documents. They are usually ways of saving money. And sometimes rough guides for people who are insecure and don't have expert knowledge of what they are doing.
But true experts almost never follow guidelines. The reason is because the guidelines are not directed towards individual patients.
So, always remember....
Guidelines are intended for populations.
Doctors treat individuals.
Nuff said !
Guidelines are intended for populations.
Doctors treat individuals.
Nuff said !