They don’t make protocols for patients like me

My body doesn’t follow protocols. Just recently I was diagnosed with multiple kidney stones from a CT scan. But for months, there has been no blood in my urine. There was no blood in my urine when the CT showed I was clearly passing a stone. I think protocols are things we invent to give ourselves a sense of safety in a chaotic world. They may statistically be a good bet, but they are by no means a rule.

This was interesting commentary until he mentioned the phrase “mid-level provider”.  Clearly, he has no idea how we “mid-level providers” are educated or how we practice.  He just wants to prove that protocols are bad, and physicians are good…  I can only speak for myself as nurse practitioner, but we are taught and work to improve our Diagnostic Reasoning skills — something the military, pilots and guess what, nursing does all the time.  Nurse practitioners do not work as individuals in silos but in collaborative practices with other providers of many different levels to provide the best and safest care for individuals.  And this proof is in our outcomes, measured time and time again in research instead of someone’s biased and uninformed opinion.

This is an incredibly important topic.  Implementing a simple systems approach to try to address complex problems and complex systems will drive mediocrity at best and will be guaranteed to result in unintended negative consequences.  The system structures for providing care need to be redesigned.  Static protocols won’t work, but relying on individuals physicians to make independent decisions also won’t work- the complexity of medical problems, medical knowledge and technology increasing at a faster and faster rate requires a new model (including physicians, mid-level providers, patients and families and many others to create a diverse care community).  Care communities are emerging to address specific patient groups and patient problems and diseases.  Defining dynamic and complex processes of care (which is messy and imperfect) and learning and improving (clinical quality improvement research) in care delivery communities (with local care coordination and management) will help transform health care for the future.  

I love how he criticized the protocol and mid-level providers without providing a reference… 
Oh, and anyone who’s read a little more deeply into Flight 1549, the Airbus fly-by-wire computer had as much to do with there success as Sully’s judgment of where to ditch the aircraft.
What’s wrong with protocols again?

I’m a patient at Kaiser, and I can assure you they run the cattle call through “treatment guidelines”, and if what you have doesn’t fit into their neat little slot, they’re flummoxed. In many cases they just throw antibiotics at it and hope for the best instead of practicing the real art of medicine. When I walk into my physicians office she’s typing away at her keyboard and barely looking at me. I feel like I’m making an airline reservation instead of being doctored. Half the time she sends me to emergency, another $50 copay because they don’t have the facilities to handle it. Effing ridiculous! Is this what Western medicine is coming to?

Protocol was devised to cover most situations, however most people also
have fixed mentality and find it easier to be ‘told’ what to do, as in
the case of the pilots of Air France plane. I am sure had they lived
they would have said, “Dang, you know I thought it a bit odd we were to
do the opposite, but you know the system told us to do it so we thought
it was right” You will find that most people don’t want to step out of
that box of questioning anything for fear of looking like an upstart and
perhaps losing their job.

 Personally I have had experience with this as a patient with many
health issues spanning many decades. After FOUR times proving I did
actually have something major going on (one was a cancer!) I questioned
the doctors on their protocol. I was told that I was a Post Traumatic
Stress Disorder patient so therefore according to ‘protocol’ I was to be
disbelieved, that I am  suffering from anxiety, and a need to feel
heard and therefore would be more likely to have ‘made up and believe’ I
had aches and pains. Had I not had the mentality that doctors are not
gods and those pains were indeed real and very debilitating, the surgery
I had just two weeks ago for several large ovarian cysts and a massive
adhesion which was wrapped around my bowel, the pain which was written
off for 2 years as ‘patient suffers anxiety, recommend counselling and
minimal treatment’ , I would have had in some near future a bowel
resection and possible ovarian cancer.

 Surely after the time the cancer was discovered you’d think they would
understand that protocol is not always efficient in some patients and
that there needs to be some real ‘go with the gut feeling’ rather than
sticking to the rules. I do understand the need for protocol, however
this next example highlights again sometimes we need to ditch it. My
engineer friend lost his job due to stepping out of the box of protocol
and indeed, found a problem which would have caused literally billions
of dollars of damage and a massive oil rig explosion. Protocol dictated
he go through the paper work which would take months, he chose to ignore
that and fly in a part. I know I am proud of him for saving many many
lives, so did the company thank him? No they fired him. They were angry
he didn’t follow protocol. The part cost $50, what cost a life?