[Rich_in_Tampa]

Quote:

Originally Posted by Sandy Practitioners often strongly resist being asked to follow standard protocols arguing that these do not apply to their patients/situations, are inconsistent with their experiences, etc. So, to promote change in practice, the incentives and encouragement must be done in a way that are not threatening or judgemental and do not jeopardize practitioner's perception of autonomy and professionalism. Tall order.

I agree with your synopsis. Sometimes, deviation from EBM is quite appropriate given the infinite number of variables for each patient. But too often, EBM is not adhered to when it should be.

An interesting insight is that ultimately it's the physician who is primarily accountable for the outcomes and anything that goes wrong. Given the sometimes onerous responsibility, it can be understood that if "someone tries to tell me how to practice" they will get a cool reception - "you wanna do it, you take the patient and the accountability."

Furthermore, EBM sometimes varies from the community standard of practice (the standard of practice is wrong). Yet from a malpractice defense perspective, adherence to the community (or state or national) standard of care is your first line of defense. Example: head CT scan has been shown to be of little or no benefit after certain types of mild head injury. Yet the CT is routinely done (minimal risk, high cost). Suppose you follow the EBM standard and omit the head CT appropriately. If even one patient out of thousands has some abnormality that would have been detected by the CT, you are vulnerable. (Of course that disregards all the incidental findings on CT that generate useless wild goose chases.)

So, I am understanding of my colleagues - there are a lot of competing mandates which sometimes are self-contradictory. A national initiative toward standardizing selected aspects of care would be helpful, with some sort of protection from liability if they are adhered to appropriately even when things go wrong.