The Medical Recipe

One of my friends told me that when he was about to move westward to United States for pursuit of further medical training his mentor told him , “So you are going to practice cookbook medicine”. I did not realize the truth in the statement at the time but thinking about it later, it dawned on me that there may be some substance in the statement. With each new day associated with practice of medicine it becomes clearer.

Medicine has become so protocolised that it may very soon begin to have an inhibitory effect on the education of students and residents. The bulk of medical progress has been made with the aid of thinking about the disease process, however faulty, in the context of an incomplete science. What the protocols in the present form are doing, particularly in the teaching institutions, is making robots that are trained to check the boxes on preprinted sheets for the particular “suspected diagnosis” or symptom. All the resident or student (read robot) has to do is print the recipe with instructions and order the nurses to get the ingredients, push them into the patient and wait for the cooking time to see what comes out of the oven.
I believe that the protocols may decrease errors like spelling errors or errors in medical prophylaxis or screening but at what cost ---at the cost of making a proper diagnosis and a tailored management plan , which is why the patient is there in the first place. I think that the saying “Coming too close to the tree and losing sight of the forest” works well here. The poor student or resident is forced to use a order set for chest pain whatever the other hundred complaints are or a heart failure order set for everyone with shortness of breath and edema etc etc etc.
Are we really teaching here? In the process of reducing errors and increasing documentation are we not compromising education of our next generation. I am of the belief that the best education obtained is at the bedside and not in lectures however grand the speaker may be, by holding the patients hand and not penning down notes in a classroom. I bet if someone would do a study of how many hours residents spend talking to patients and thinking the result would surprise many. There needs to be some serious revision of the proper use of the 80 work hours the proper use of protocols and prewritten orders so that we can boast of giving the world some great clinicians and not check marking machines!