Rules.

They’re everywhere. Especially in medicine.

We’re confronted with them daily, sometimes minute-to-minute, but occasionally, we’re also confronted with the question of whether or not the rules are in the patient’s best interest.

Some rules are designed to protect patients. Others are designed to protect insurance company’s bottom lines at the expense of patient health. Maybe a patient needs a procedure, but if we read the insurance guidelines literally, then they wouldn’t qualify…

The most difficult cases are often those wrapped around proper diagnosis. An expensive scan might provide diagnostic clues, but we can’t be sure of that can we? It might end up proving pointless. But that’s the entire point of diagnostic procedures, if we already knew what was wrong, we wouldn’t need them in the first place.

Remember the “paint by numbers” kits from kindergarten? As long as you painted within the lines and according to the colors indicated by each number within the lines, you’d get the picture that the company wanted you to get.

I recently asked a nurse what the most difficult part of his job was. His answer was instantaneous: protocol. He’s won his hospital’s top nursing award. More than once. And the most difficult part of his job is not being able to customize treatment as uniquely as each patient’s history and physiology. The hardest part of his job is having to paint inside the lines.

I recently watched an episode of a medical drama in which the surgeons (actors) performed a moya-moya surgery. They didn’t have a flowprobe to check the flow rates after. Sounds crazy, doesn’t it? Why, in a surgery that exists to augment flow, did they not bother to check that flow? Especially in a TV show that’s meant to represent the current pinnacle of medicine. Flow measurement isn't part of the rules. 

So we need to change the rules.

This isn’t about being rebels, with or without a cause. It’s about working together for the changes we know are needed. And we shouldn’t get discouraged, because history is on our side. We began with stone tools, in a cave. After that, we bled people. Anesthesia used to be a hammer. Those things were protocol. (More or less.) Now we perform computerized surgeries with robots. We rebuild the tiny vessels inside people’s brains. Look how far we’ve come.

And we’ve come that far because the rules change.

Because we change them.

Thanks for reading, 

                  Transonic Systems, Inc

                                     The Measure of Better Results