Thursday, 24 January 2008

Should Medicine Become Protocol Driven??

Dear Bloggers

What are medical protocols and should we be using them?

Medical protocols are a step wise guide to treating a vast array of conditions based on current evidence and moreover, on the provision of local services. We have all seen medical textbooks with 'their way' of doing things, and then pick up a different textbook to find that it is done slightly differently in that. With so many doctors using so many different opinions, it is sometimes difficult to know which one to choose. Do we base our final decision on how many grey hairs the senior doctors has or do we base it on evidence derived from trials and case-reports??

In a medical world of constantly changing medical information, it is sometimes difficult to remain up-to-date. It is important to remain appraised of new information because patients benefit directly from it. However, if we are all doing things a little bit differently, we should consider adopting a single way of 'best practise' so that there is standardisation throughout departments and throughout hospitals to ensure a basic and sustained uniformity of basic treatment.

Such methodologies do exist. Many UK hospitals have protocols for DVT, PE, Cellulitis, AMI, Stroke, Community Acquired Pneumonia etc... which are rigorously followed to be compliant with the modern evidence based practises. Hence, nevertheless who is on duty and nevertheless to the time of day or night, the basic standard of best practise can be applied.

I for one, having worked night duties, it was sometimes difficult to remain thinking clearly, quickly and precisely at 3 o'clock in the morning, and hence, following protocols for common medical conditions ensured that the work-up and treatment were followed appropriately and accurately. This can be especially useful for junior doctors who may not be accustomed to all the medical processes for safe patient care.

These types of protocols are especially good for the management of antibiotic use in the hospital inpatients and in the outpatient clinic. A protocol based on local resistance rates, severity of illness, and of course, cost to benefit, are used in many hospitals to guide the physicians on what they may be allowed to prescribe. Hence, most hospitals will not allow drugs such as the carbapenems to be utilised unless specified by a Consultant. More traditional antibiotics are used in combinations to provide effective broad spectrum cover and this cuts down on the abuse of antibiotics plus gives definite rules to the doctors on prescribing. In a World of ever expensive treatments, being cost effective is now very important. Protocols can help with this process.

Some may say that they do not want their autonomy taken away from them and they should have the ability to make changes and do things the way that they see fit. Indeed, for a seasoned senior doctor, the use of a protocol may not be necessary because they may have the knowledge to know what treatments should be administered and why. This is not the case for junior doctors who are simply trying to survive the long nights of sleeplessness and barrage of the daytime problems. The use of a protocol to guide them exactly how it should be done is both helpful and safe.

If a problem was to occur, then the junior doctor would also have the legal protection that they had followed the pre-specified hospital protocol.

Of course, not all things in medicine can be fastened down to a rigid protocol as there needs to be leeway and flexibility. However, for common medical problems as I have laid out above, the use of hospital adopted protocols that are available on every ward or outpatient in paper or electronic format can ensure that any doctor can appropriately investigate and administer the correct treatments at any time of day or night.

I for one have trained in a system that began to adopt the protocols for medicine several years ago and I found it extremely helpful.

Please consider... :-)

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