Standards Dread

Healthcare in general and from top to bottom seems to have an absolute dread of standards. Physicians (many if not most) will flop about like a fish on a hook whenever the word comes up. They fight no matter how the subject is introduced. Whether it be "guidelines", "pathways" or even "best practice", it doesn't matter. As an interested consumer, I find this disturbing on several accounts.

1. It demonstrates such a me-first, tunnel vision mentality that, if I were given a clear choice, I would run as fast as I could away from this and toward anyone who could demonstrate that they do, in fact, adhere to standards.
2. It has a huge--and negative--effect on everyone else in the healthcare organization. The physician role is so central in healthcare that, if there is no reliable standard (process) for the physician, then nursing, registration, coding, billing, systems developers..., no one can predict from one day to the next or from one patient to the next what they're going to be asked to do.
3. It holds the practice of medicine back to a level not much different than was seen in the 18th century. Oh, sure, we have better drugs now and diagnostic magic is performed many times a day using the lastest technology, but the outcome for me, the patient, is so dependent on the physician I see that "bedside manner" often seems to be the most critical factor in outcomes.

In my 60+ years of life on this planet, I have seen that humanity can be put into two groups--those who appreciate standards and those who do not. Further, it has always seemed that the second group is the cause of problems not ony for themselves, but for everyone. Let's take a kind of standard that we're all familiar with--traffic laws. Those who flout the traffic laws are a hazard to everyone else on or near the road. And note that consistency and predictability are key. Traffic laws work because they produce consistency and the ability to predict with some assurance what the other guy is going to do. Those two principles keep everything flowing smoothly and with minimal (and manageable) disturbance.

We do not realize fully, the value of the standards we employ in this country. John Adams is the one who noted that we are governed by laws not men. Bribery is a recognized way to get things done in many parts of the world. Imagine having to find the right person (how do you do that?), paying to get their attention, then finding out that they weren't the right pewrson after all and having to start again. We sometimes go through that with building and remodeling contractors and it makes the evening news. Healthcare isn't much different EXCEPT that we don't get as heated about it because someone else is paying.

I constantly wonder at the inability of the insurance companies to get provider organizations to create and use standards.

Today, we are being told that technology is the key to the healthcare crisis (which is a crisis of out-of-control costs). I am going on record here that technology will only drive costs up unless the healthcare "system", beginning with physicians, learns to cherish standards, utilize standards, trade on standards.

We, the patients, must demand a system in which we can rely on standards to produce outcome and efficacy data allowing comparison of physicians and organizations. It's a sad system in which the only statistics available for comparison are mortality numbers.