The Kibbe-Klepper challenge to medicine as usual
After re-reading the post Brian Klepper and David Kibbe offered The Healthcare Blog Monday, and spending some time with my own doctor and her latest intern, the profession's objection to their approach crystallized in my mind.
Doctors don't want to become bus drivers.
Kibbe and Klepper want to focus on decision support, give patients control of their data, link the Web more tightly to the profession, make doctors accountable through data, simplify claims, and generally make things more collaborative.
Sounds great. How would we do it? As Klepper told me in our interview, through checklists and detailed protocols, backed by huge databases. Do what the data says works.
By funneling existing cases through decision support software, Klepper said, we can know what works best, make that the standard, and insist that deviations be documented.
Again, sounds great. But my intern had a problem with that. Different doctors look at studies in different ways. They have different reactions, and choose different approaches. Medicine is not as cut-and-dried as he thought when he started studying.
While he spoke his mentor (my doctor) nodded sagely. I asked about a recent study showing calcium channel blockers outperforming diuretics in hypertensives like me.
She had seen the study but there was no new directive on it, she said curtly. Then, after consulting with her colleague behind closed doors, she brought in a new prescription. For the calcium channel blocker.
Would this have happened had I not brought new data in with me? Maybe. My diastolic is stubbornly high -- the "try this" method of medicine might indicate trying something else anyway.
What Klepper and Kibbe want to do is make this doctor-patient interaction routine, but also set down what doctors should do, based on an immense body of evidence rather than what any doctor might see in their own practice.
Under the current system a doctor uses their own instincts, and their own reading of the literature, deciding independently whether to follow the latest guidelines and directives or not.
Under the system Kibbe and Klepper propose, any deviation would demand documentation. Doctors who routinely disagree with the standard protocol would come under quick scrutiny. The incentive would be to practice by rote.
Medicine is both science and art, say doctors. But for how long will it stay that way in a world where data rules? (Hence Van Gogh's Starry Night, a masterpiece even when just sung about.)