Medicine needs another way.

Are the uniform protocols in disease management are healthy?

By Dr.Srinivas Raju.C

How the doctors and treatment of diseases  regulated  in India?

In one sentence we can say, “The four pillars of the nation along with insurers are, trying to rope the medical profession to their stands.

For every ailment they are trying to dictate what investigations a doctor can do?

 What medicines a doctor should prescribe, how many days a doctor should admit the patient in a hospital, how much fees a doctor shall charge!

Dictating the norms, dictating the management protocols to doctors.

Everyone is trying to slave the doctor and bend the medical profession to suit their fancies.

Is it the medicine? Is the doctor is a robot? Adding to it, they are encouraging robots to do surgeries!

What they think of medical profession? Sabotage it? Surrogate it?

All they want is charts....logarithms... conclusions.... printed prescriptions.

They don't understand the potential of healing, because they can't discriminate between treatment of the disease and healing of the patient.

We all know that the medicine is science but healing is an art.

Homogenization or evidence based treatment protocols make medical treatment causing number of fatalities.

What we need is variations in treatment depending on patient's biochemical nature and responsiveness.

But, what the doctors are facing is, that the Variation in the treatment looked with disdain and counting as wastefulness, lack of evidence and even capricious care. To minimize variation, insurers and medical specialty societies have banded together to produce a dizzying array of treatment guidelines for everything from asthma to diabetes & from fever to gout. 

The evidence for most treatments in medicine remains weak. In the absence of good evidence, recommending one treatment over another, trying to implement syndromic management is irrational.

As per one report that 1 million Indians die each year because the care they get is not based on the best available evidence.

Most treatment recommendations are based on expert opinions not randomized controlled trials. Rarely is there one best option.

Patient preferences and their economic background and family conditions have to be taken into consideration, too in the management of disease. 

Mandated treatment protocols!

Some times,Treatment guidelines, often accompanied by a de facto mandate, are frequently reversed.

Only a few years ago, for example, beta-blocker drugs were routinely recommended for almost all patients undergoing non-cardiac surgery. Since then, research has shown that these drugs may significantly increase the risk of stroke at the time of surgery.

What is in vogue today is often discarded tomorrow.

Hormone replacement therapy for women after menopause is an example of a once widely implemented treatment that we have now largely abandoned.

“Science is not static but rather constantly evolving, “But we can lower the dangers associated with these reversals if we encourage doctors and patients to use their own judgment when following the guidelines.

Not surprisingly, guidelines and checklists are unpopular among most global physicians. Instead of being allowed to deliver “patient-centered” care, many physicians feel they are being co-opted by regulations.

Some doctors feel pressured to prescribe “mandated” treatment, even to frail older adults who may not benefit. Guidelines are supposed to assist and advise. But all too often, recommended care in certain situations becomes mandated care in all situations.

Transition in health delivery

The next phase of quality improvement will be a move away from homogenizing care and toward personalizing it, perhaps with the help of genomic research. 

Neither the old approach, in which seemingly every patient was treated differently, nor the new one, where we try to treat them all the same, has worked well.

 Medicine needs another way.
Plz think over.......