People who worry about death panels are missing the forests for the trees. Yes, people with expensive-to-treat conditions may someday be denied life-saving treatment because of ObamaCare. But there is a far greater danger for ordinary mortals: government and its health insurance proxies telling doctors how to practice medicine.
In treating patients with various symptoms, doctors are increasingly pressured to follow guidelines or protocols. This "cookbook" approach to medicine is the opposite of personalized medicine — an approach which aims to tailor the therapy to the characteristics of the patient, including her genetic makeup.
Before criticizing it, let me say something good about the "cookbook" approach. I think a doctor would be foolish to ignore protocols. Being aware of how other professionals have treated conditions and what outcomes they have experienced is part of being on top of what is happening in the medical profession in general and the doctor's specialty in particular.
In MinuteClinics and in other walk-in primary care retail clinics around the country, nurses are doing a superb job of following computerized protocols. In fact they seem to follow best practices better than traditional primary care doctors. They also seem to pretty good at recognizing when a patient's condition is outside their area of expertise and referring that patient to a specialist or to an emergency room for more complex treatment.
But things will go wrong if the cookbook becomes a master rather than a servant; if it becomes a book of orders rather than a book of suggestions; and if complying with endless checklists takes valuable time away from patient care. Yet that is exactly what is happening in American medicine.
The cookbook that MinuteClinic nurses follow is a cookbook created in the marketplace for the purpose of meeting the needs of cash paying customers. MinuteClinic has an incentive to weigh costs against benefits in doing what it does. If a nurse has to type too much low-value information into her computer terminal, she will be able to see fewer patients and earn less revenue for the clinic. The cost of information overload will be judged not worth the benefit.
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