Doctors, Skilled Workers and Protocols
It’s a never-ending debate, made more intense in this era of cost-control and evidence-based medicine: What kind of latitude should doctors have in treating patients? Should doctors be looked upon as “skilled workers” performing highly complex work, but following strict protocols or should they be seen as professionals, working independently and applying their knowledge to an unending stream of unique situations.
Consider just a few examples:
- A 57- year old man slips on the ice, breaks his hip and goes to his local hospital where a general surgeon pins the shattered bones back together—well, almost. When the hip failed to heal correctly the patient sought out an orthopedic surgeon specializing in trauma conditions at a large urban hospital who said simply, “I can see the problem right away. They followed the protocol, but in your case it wasn’t enough.”
- A resident being "trained" by an attending doctor was about to administer a drug using the protocol developed by that hospital's clinical department. The attending doctor interrupted and said, "Don't do it that way. I've been a doing this for over 20 years, and that way is stupid."
- An ob/gyn practicing in an extremely rural environment—the nearest other ob-gyn is more than an hour’s drive away—says that “the only thing keeping my patients and me safe is well established and tested protocol and procedure.”
Here at Saba University School of Medicine, our students wrestle with questions like these every day—in the clinical training that starts from virtually the moment they step on campus, in classes on medical ethics, and in the research program on medical literature all students are required to complete by the end of their fifth semester. Learn more about Saba’s Curriculum.
Of course, there are no simple answers. Today’s protocols are in many cases based on extensive clinical research that far exceeds the independent experience of any one physician. At the same time, no protocol can be right 100% of the time and there are numerous examples in the history of medicine of practitioners who bucked the prevailing consensus and were proved right.
For interesting discussions of these questions see Doctors are more than just skilled workers. Here’s why. And "Protocols are for nurses."