But it is exactly this reaction that provides clues to our current state. No one prepared us for the fact that healthcare delivery is a social science, so frustration and avoidance are merely natural reflections of our immaturity. If we did receive any coaching, it tended to be of the Monday-morning-quarterback school, autocratic and self-serving in nature. We were trained to critique only the finer details of scientific “fact,” not humans in context. How, then, are we to improve our care when we can barely handle the variation?
Advanced Concepts
Adapting a Darwinian perspective, we might hunt out the highly developed and advanced tribes in our midst. One such tribe is pediatric oncology. For decades, almost all variation in pediatric oncology has been controlled through treatment protocols tailored to the particular risk factors of the patient, not the physician. Although this ostensibly improves quality of care, it has had an even greater impact on learning and eventual outcomes.
For this reason and this reason alone, if your 18-year-old child develops leukemia, you probably want to send them to a pediatric oncologist rather than an adult oncologist.7 Survival rates are better because pediatric oncologists have been able to rapidly learn from the enrollment of almost all patients into trials with standardized treatment protocols. By collecting data on a limited number of options and sharing information across practices, true rapid-cycle improvement has materialized.
The key here is not the degree of standardization or the creation of large-scale research networks. It is the extent to which independent practitioners are able to sacrifice their individual beliefs in order to partner for the greater good. Growth and learning do not occur in isolation. A team-based approach, in the setting of standardization and measurement, will accelerate the pace of our evolution. Think about this the next time you feel like throwing a coconut at the infectious-disease consultant who dares cross your island of practice. For if it is human to vary, then only through collaboration may we truly divine. TH
Dr. Shen is The Hospitalist’s pediatric editor. Read his monthly review of pediatric research in our “In the Literature” section (see p. 16).
References
- Wennberg J, Gittelsohn. Small area variations in health care delivery. Science. 1973:182(117):1102-1108.
- Eisenberg JM. Doctors’ Decisions and the Cost of Medical Care: The Reasons for Doctor’s Practice Patterns and Ways to Change Them. Chicago: Health Administration Press; 1986.