Why implementing regimented care may be more complicated than setting the rule in the first place.
Practicing medicine is an inexact science and it has never been easy. There is an undercurrent of disagreement that goes on in academic teaching centers between the professors and the local practicing physicians. As we discussed earlier, the Choose Wisely program was an attempt to use scientific data to compile a list of commonly ordered medical procedures, which may not benefit patients.
It is very easy to write the guidelines but, as a frontline physician, there are many barriers to implementing them. One of the ways that physicians make decisions is by intuition or by doing things the way they have always done it.
If you follow the guidelines presented by 10 specialty organizations, I suspect it will come directly in conflict with how you, your colleagues, or your residents practice. It may even come into conflict with your own belief systems which, as I pointed out earlier, may be adversely influenced by intuitive thinking and bias. Having said that, I am going to present some of the guidelines, which you may or may not agree with but should certainly give you reason to think carefully, investigate further, and discuss.
These guidelines were created from specialists in various medical organizations and might therefore be considered suspicious by local practicing physicians. This is a so-called town versus gown conflict. It goes both ways with some of the university physicians being the worst offenders of overtreatment and some of the community physicians being the worst offenders of either under or overtreatment.
I think, though, it is fair to say that one of the major problems in American medicine is not undertreatment but rather overtreatment.
Here is a sampling of recommendations from the Society of Orthopedic Medicine:
From the American College of Cardiology comes following recommendations:
From the American Academy of Neurology comes the following recommendations:
From the American Academy of Nursing comes following recommendations:
Some of these recommendations are common sense but some of them may be counter to hospital policy or how you were taught. Overall there were 245 pages of recommendations published and this is only a sampling. It is not always easy to do what you think is right. In order to know what you are doing is right, however, you need to study and learn about various procedures and how things change.
Do not just assume that the way you have always done things is the way they should be done. Lastly, do not assume that doing the right thing is always going to be the easiest thing to do.