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My Patient Ain’t No Automobile! Heartfelt Musings of a Confused Physician

Indranil "Neil" Chakraborty, MBBS, MD, DNB
Director, Division of Neuroanesthesiology
Associate Professor
Dept. of Anesthesiology
University of Arkansas for Medical Sciences

George Mashour, MD, PhD
Indranil "Neil" Chakraborty, MBBS, MD, DNB

Is excessive “protocolization” of medicine killing free thinking? Are concepts and theories that are good for heavy industry also good for my patient? Is the “art” of medicine still alive? Or is it dying its own slow and illogical death?

Having grown up in the 70s and 80s and having been trained in the 90s, the present environment in managed patient care often feels conflicting, and dare I say, claustrophobic! Instead of thinking about my next best approach, I find myself frantically searching for the protocol! So often I feel as if I am in an apocalyptic science fiction disaster movie set, standing alone among the noise, mangled steel, smoke and rubble of a recently destroyed city trying to figure out where I came from and what my next move should be.

More often than not, we hear stories of patients getting wrong or inappropriate medications just because they were ordered as a part of a protocol! Unnecessary medicines are being administered, tests being ordered and excessive procedures being performed because it is the norm! This not only makes patient care expensive but outright hazardous. Somewhere in between, free clinical thinking is being lost or discouraged.

The “mechanization” of the medical thinking process is complete! We have come to a point where every loose end of patient care is being identified and we are feeling morally obligated to do something about it. Every small little detail is being over-processed, excessively analyzed and feverishly churned out into this complex maze of analytical data matrices and management instruments far above and beyond the realm of most mortals. But in all this frenzy and melee, is the poor patient being lost somewhere? In this dizzying potpourri of Lean and Six Sigma and everything else, is there any role for that human uncertainty which we know can never be eliminated? In the relentless pursuit of perfection, did we just forget that the patient is a human being and no two human beings can be the same? Does the prospect of that unknown differential diagnosis still excite clinicians and make them tremble with joy?

Don’t get me wrong, I want my patient safe but my patient ain’t no automobile!

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