I believe that the problem with standardization is the threat it poses to professional autonomy. The professionalization of the medical field was based upon the concept of autonomy as it allows patients to put more trust in their doctors and ultimately gives doctors moral and scientific authority. If we allow standards to intervene in medical decision making, physicians will no longer be able to exercise their own professional discretion, harming the credibility of the entire field. This is why, I believe, that while evidence based medicine is an important part of clinical medicine, analyzing patients and treatments on a case by case basis should not be completely overshadowed by standardization.
Monday, April 23, 2012
Instinct, Reasoning, and Guidelines
An important aspect of The Gold Standard is that Timmermans and Berg attempt to explore the reasoning and psychological factors of the individuals when attempting to understand why standardization in the medical field is met with either acceptance or resistance. I believe that this is important because it is different that simply analyzing group dynamics within the profession. My interpretation of why compliance with clinical practice guidelines is relatively low is that on the individual level, physicians are instinctively not receptive to these guidelines. As illustrated in this work, evidence based medicine is based on probability and statistical constructs. As a result, such guidelines function to treat the “average patient,” a constructed through such statistical analysis. Physicians, however, live in a different reality than the construct of the average patient, one where probability cannot always be trusted. While physicians may accept the principle of the idea of evidence based medicine and guidelines, their instinct may overtake their reasoning in actual practice. On the individual level, physicians may agree that the evidence based guidelines are generally valid, but decline to follow such guidelines after analyzing specific cases and determining that they are not appropriate for the situation. As a result, a dichotomy is created between what physicians say they believe and what they do in while practicing.