With a second poignant op-ed in the Wall Street Journal within the span of a month, Drs. Jerone Groopman and Pamela Hartzband take on quality measures.

It’s no secret that I’ve been a proponent of increased standardization in medical care, adhering the evidence-based practice guidelines.

That assumes, however, that the recommendations themselves are rigorous and have been shown to help patients.

And that assumption, as the op-ed argues, is sometimes faulty.

The issue of tight glucose control in the intensive care setting, touched upon recently here, was discussed, and indeed, “show[s] why rigid and punitive rules to broadly standardize care for all patients often break down. Human beings are not uniform in their biology. A disease with many effects on multiple organs, like diabetes, acts differently in different people. Medicine is an imperfect science, and its study is also imperfect. Information evolves and changes. Rather than rigidity, flexibility is appropriate in applying evidence from clinical trials.”

While some policy wonks, such as those from the Dartmouth Atlas, chastise practice variability, the authors say “what is best sometimes deviates from the norms.”

But if that’s the case, should we allow doctors free rein in their treatment decisions? That’s one extreme, but however, demanding that doctors follow stringent guidelines without room for flexibility doesn’t seem to be the answer either.