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PRO: confronting resistance to rule-based medicine is essential to improving outcomes

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Blakey, John, Brown, M., Pinchin, J., Barley, M. and Sharples, S. (2015) 'PRO: confronting resistance to rule-based medicine is essential to improving outcomes'. Thorax, Vol 70, Issue 2, pp. 110-111.

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Abstract

The past 20 years have seen two great changes in the practice of medicine: the widespread adoption of evidence-based medicine, and the increasing challenge of managing complex multimorbid patients. Both these developments have resulted in clinical rules and protocols becoming ever more abundant and increasingly critical to delivering safe and effective patient care. These evidence-based clinical rules perform at least as well as expert opinion, and the increasing volume and quality of available clinical data suggests their performance could continue to improve. This article considers why clinicians deviate from effective rules, highlighting key issues such as the persisting culture of heroism, institutional inertia, deference to authority and personal heuristics. We argue that better rules can be created, and that clinical improvements will follow if there is a ‘common knowledge’ of these rules. Furthermore, we argue that there is a ceiling to the effectiveness of any rule, even one as simple as ensuring hand hygiene, unless individuals are held accountable for transgressions.

Item Type: Article
Subjects: W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care
W General Medicine. Health Professions > Professional practice > W88 Administrative work. Teaching. Research
WB Practice of Medicine > WB 102.5 Clinical medicine - evidence-based practice
WX Hospitals and Other Health Facilities > Hospital Administration > WX 162 Point-of-care. Patient care planning.
WX Hospitals and Other Health Facilities > Clinical Departments and Units > WX 203 Medical personnel. Interns. Staff manuals. Ward manuals and precedent books
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1136/thoraxjnl-2014-205986
Depositing User: Lynn Roberts-Maloney
Date Deposited: 16 Jan 2015 11:06
Last Modified: 06 Feb 2018 13:08
URI: https://archive.lstmed.ac.uk/id/eprint/4760

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