This article is more than 5 years old. Information may no longer be current.
Treatment should be tailored to each patient
Click Here to Manage Email Alerts
To the Editor:
During the past few years, I have witnessed a trend by hospitals, insurance carriers and the government toward implementing what have been titled “best practice models.” Physicians are being encouraged, cajoled and even mandated to follow these guidelines, which I find troubling.
Early in my career as a student and resident, I was repeatedly told there was no such thing as “cookbook medicine”— each patient is as distinct as his or her treatment. Now, we are trying to have a “one-size-fits-all” treatment. Statistical analyses and outcome-driven parameters are not always a substitute for clinical experience and intuition.
I ask, “Who will design these practice models and monitor its effectiveness?” I lived through the era when coumadin (Bristol-Myers Squibb), heparin and Lovenox (Sanofi) were de rigueur. I was disappointed by effectiveness, shortcomings and complications. Early on, I was impressed by the work of Paul Lotke, MD, as he advocated for the use of aspirin for deep vein thrombosis prophylaxis. I implemented this approach, along with mechanical prophylaxis and early mobilization, into my joint replacement regimen. Even in my position as chairman of the orthopedic department, I was reported to administration by the nursing staff and experienced heated resistance from my medical colleagues. They would quote the guidelines from the College of Chest Physicians, try to overwrite my orders and even withhold referrals. I was vindicated by time and progress. From the onset, I was deeply concerned about metal ion release from metal/metal hips despite all the claims from the experts and elected not to perform this procedure. Time proved their error and now I worry about the long-term effects of elevated ion levels on hepatic and renal function. Are these the same experts who will develop what are becoming mandatory guidelines?
I am not opposed to outcome-based studies, a total joint registry or presentation of long-term clinical results, but let us not forget that our field is constantly changing and not all short-term results live up to expectations. We must never remove from the physician the ability to tailor his or her treatment to the needs of his or her patient rather than strict adherence to a sometimes arbitrary protocol.
— John T. Andronaco, MD
Chairman Emeritus,
Hackensack University Medical Center
Hackensack, NJ
Disclosure: Andronaco reports no relevant financial disclosures.