When you get sick, you want personal attention. You want your doctor to listen to you properly and analyze your symptoms in your unique context and figure out a treatment that would fit your individual need. If that sounds like your doctor, you are lucky. There is a system in place that threatens to eliminate doctors like that and replace them with doctors who just check boxes.
People who wanted to improve the quality of medical care probably did not intend to use the term “quality” as checking boxes but that is exactly how it is practiced now. When every other field has achieved progress and innovation by thinking outside the box, medical practice has been pushed back into the box in a misguided attempt to improve quality of care. The root cause of this problem is how they imported the concept of “quality” into medical practice.
When you look at quality in the manufacturing of iPhones, you look at the uniformity of the process. You want the exact same precision guided mechanism to insure every single iPhone goes through the exact same process as every other iPhone. This is how quality is defined in industrial manufacturing and it is the job of the quality control people to insure this uniformity.
Even when two people are sick with the exact same disease, they do not have exact same symptoms and they do not benefit from the exact same treatment. What particular symptoms a particular patient experiences from a particular disease depends on the unique circumstances of the patient. When doctors blindly check the boxes and follow the algorithm, they skip the most important part of evaluating the patient —clinical judgement.
If checking the boxes and following the algorithms were proving quality care, we would have no need for human doctors; computers would have replaced doctors.
Only human doctors can truly understand human patients. When doctors listen to their patients with open minds, they gather important information to know the underlying disease process. Only human doctors can use such information to make judgement calls that save lives. Boxes and algorithms work for processing of information by computers but they close the human mind to possibilities; human thinking and judgement gets literally cramped into a box. Life saving judgement calls are hard to make with this closed mindset.
The boxes are here to stay. The proponents of so called “quality” have ingrained those boxes so deep into our system that it is impossible to get rid of them. However, it does not mean that doctors have to practice medicine from those boxes. Doctors can still practice medicine with open mind and use those boxes and algorithms as after-thoughts— a final checklist to make sure they did not overlook anything. The problem arises when doctors actually use the boxes and the algorithms to guide their decisions.
As a patient, it is important for you to understand that boxes and algorithms have been thrown out to your doctor and they are here to stay. How your doctor decides to use those boxes may have a great implication on your care. Once you understand this concept, you can learn to look for signs that your doctor may be just checking the boxes. In the next post, I will give you some signs to look for and I will also tell you what you can do to try to get your doctor out of the box.