---- Physician autonomy must be balanced with team-based standardization
December 23, 2008-Despite increased emphasis on patient safety, little progress has been made in making hospitals safer, says Johns Hopkins critical care specialist Peter Pronovost, M.D., Ph.D., in an article in the Dec. 24 issue of the Journal of the American Medical Association.
He identifies physician autonomy and a lack of standardization of safety protocols as the culprits.
“It’s been almost 10 years since the Institute of Medicine published To Err Is Human, its treatise on the need for increased patient safety initiatives at hospitals,” says Pronovost. “Yet we really haven’t made much progress.” According to Pronovost, an average hospitalized adult will receive recommended therapy only 53 percent of the time. This accounts, in part, for the nearly 100,000 patients who die each year in the United States because of hospital error.
“Imagine,” says Pronovost, America has some of the best doctors and medicine in the world, yet we are only getting it right half of the time.”
He says improvements in patient safety must incorporate three principles: First, physicians must balance their autonomy with team-based standardized care protocols. Informed decisions based on using standardized protocols will give physicians more time to spend on difficult cases, in which standardization is less effective.
Second, medical students and residents need to be trained in this new approach so they are fully socialized in their roles as patient agents rather than autonomous decision makers. They should understand that outcomes of patient care are a product of the systems and tools designed to deliver that care. To enhance trust and foster effective teamwork, students from different clinical disciplines should train together.
Third, the process by which evidence-based standards and protocols are developed should itself be standardized and made clear. If physicians are to surrender autonomy, evidence biases and uncertainties regarding the risks, benefits and costs for patients, clinicians and payers should be made explicit. Groups developing such standards should represent a diverse group of stakeholders consisting of patients, physicians, methodologists, regulators and payers to ensure that all points of views are reflected in the final products.
“Gone are the days when a doctor was on his own carrying all the tools of modern medicine in a black leather bag,” Pronovost says. “Today, much of care is team based, and the wealth of techniques and wisdom is too much for one doctor to keep in his or her head. Standardization and a move away from physician autonomy will help guarantee that each patient receives the best treatment available.”
Media Contacts: Eric Vohr