Tuesday, April 24, 2012

Standardization and Creativity


There are several significant points that Timmermans and Berg make in The Gold Standard.  First of all, it is important to realize and understand the implications of standardization.  They show how standardization leads to a more unified field thus creating a profession.  This was discussed in chapter one in regards to the standardizing of patient records.  Doctors used to simply jot down notes about their patients in their own personal notebooks.  Over time, standards were implemented that required patient records to be kept at their bedside.  Along with these changes came specialized doctors, so patients would sometimes see multiple doctors.  These records were important so all the doctors attending to an individual were one the same page and knew the same information.  Today, this is seems so logical and hard to imagine a time without a detailed medical record.  In regards to medical records, standardization seems like a good thing.   We should hope that our doctors know our past medical history when taking care of us.  However, they mention some arguments against standardization that state it stifles doctors’ work practices, and drains their creativity.  Doctors should follow certain guidelines and standards when diagnosing patients and determining what treatment they should receive.  This supports the practice of evidence-based medicine.  Doctors should advise patients on the best available methods, which is determined through studies and tests.  However, the doctor must always remember to take into consideration the wishes of the patient.  In regards to the claim that standardization drains the doctor’s creativity, I believe the doctor still needs to be creative in his diagnosis.  This argument relates to the other discussions we have had in class as to what makes a good doctor, and especially to How Doctors Think.  Doctors still need to take creativity into account when diagnosing a patient, since every case is individual.  

6 comments:

  1. I agree with Angela's take on the benefits of standardization. Standardization in medicine is very important for organizational purposes- the standardization of patient records is a great example. However, I have always been a bit skeptical by the argument that standardization "stifles doctors creativity". I feel that medicine is based so much in science that some evidence based medicine is always going to be necessary. I do think that creativity is an important characteristic in a doctor, but I think it should be viewed as an additional characteristic that can be used to enhance evidence based medicine. You can have both!

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  2. This was an awesome summary of the arguments Angela, and you brought up some great points. I would add that I don't think creativity is something that can be taught when it comes to medicine, which might be one of the reasons why it's not emphasized in the medical field. Thinking clinically and creatively only comes with practice and developing the skill takes time and effort and requires a different kind of mindset that the average doctor might lack because of the way our medical education system works. Also, evidence based medicine and standardization could be used as sort of a cop-out for doctors to blame their mistakes on the system instead of looking at their own mistakes and why they personally failed to adequately treat someone.

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  3. I agree with you. I think that standardization has certainly removed a certain degree of creativity that used to exist within the medical field initially, but it has not removed all of it. But I also think that standardization has had this effect on all industries and is not limited to just medicine. Maybe my conception of medicine is limited to House, but it seems to me that knowing which procedure to apply and how to implement the existing knowledge requires a good degree of creativity.

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  4. I too agree that standardization has been very beneficial for the medical community, especially when it comes to medical records. It is part of the doctor's job to use the standards of EBM as a tool in the diagnosis and treatment processes, but by no means is it his or her only tool. More seasoned doctors can use their past experiences to aid in the diagnosis and treatment process; however, I think that sometimes experience can be a hindrance that can create an arrogant doctor to believe he or she already knows what to expect, and thus can leave him or her grossly unprepared or unwilling to try alternative (and possibly more effective) treatments. This is where I think creativity plays the biggest role, in treatment. Treatment methods can greatly be determined by patient's beliefs, whether religious or personal. Newer doctors can lend another pair of eyes and give a fresh perspective on the diagnosis and treatment processes. This goes back to why I believe academic hospitals to be so important. Not only do they help train future doctors, but they also give patients the benefit of collaborative medicine between young doctors and experienced doctors.

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  5. I agree that standardization has been beneficial for the medical community by providing basic guidelines and rules and procedures that the doctor needs to follow exactly when they take a patients medical history and other physical characteristics. I do believe that it has limited some creativity though in the practice though because the doctors are following such a rigid procedural outline that they have really no room for error and therefore no room to think outside the box, in some cases at least. The density and depth in which the clinical practice guidelines go is so extensive and in some ways these can make doctors weary to move off the track that they are taught legally and academically and ethically when treating a patient. However, there can be some cases in which they need to do this because not all patient cases follow a guideline or a textbook outline. Especially, in agreement with the above comment, when the doctor is experience they might not think of creative ways to treat patients because they believe they have seen it all and they know they are right nad are working within the guidelines.

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  6. I also agree that there are pros and cons to standardization. The importance of medical records have gotten very advanced. This past month I had to go to the emergency room for the first time in my life. To my surprise, they had my medical records because the hospital I was born in(located in Brooklyn) shared medical records with the hospital I went to(located in Queens). However, like everyone has stated, medical records can affect a doctor's creativity. I believe that the system of using guidelines should not be changed but rather the way doctors diagnose should change for more effectiveness. My first reaction was that doctors should be aware of what their weaknesses and strengths are. Therefore, if a doctor knows from experience that working with guidelines does not bring good results he/she should try out other ways of diagnosing patients. And if another doctor sees that working with guidelines does give good results, he/she should continue to work with them. However, because each case is different I began to realize that doctors have to find the balance of using different tools. Therefore, finding that balance of using guidelines and creativity is difficult and it can be a cycle of experimenting with patients.

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