Since the impact of Big Insurance, Big PhRMA, and Big Admin, physician and nursing direction in health care delivery has taken a nose dive.
I'd go so far as to say that there isn't even - now - the "science of medicine".
Everything is "cookie cutter" and "standard of care" regardless of whether or not it fits the patient.
The same goes for techinque!
And fluff TV programs like the "doctors" don't give you the real story.
I've been working on protocls for improved infection protocols since the early 90s. So far there is no change. And I know things CAN be better.
This Challenge was placed on the table in 2003
http://naturalhealthnews.blogspot.com/2008/09/heads-are-still-in-sand-on-this-one.html
http://naturalhealthnews.blogspot.com/2008/04/improving-hospital-health.html
Our protocol was recently updated in 2010.
And consider how nutritional status plays such an important role in hospital health
Another commentary caught my eye, today, and it is directly related to my comments about the art of medicine.Update: Hospitals Still Killing Their Patients
Why aren't hospitals adopting best practices?| Mon Jul. 12, 2010 8:58 PM PDTIf you read Atul Gawande's New Yorker article [1] about central line infections three years ago, you already know that CRBSIs — catheter-related bloodstream infections — maim and kill tens of thousands of hospital patients a year. And you also know that these infections can be reduced nearly to zero through the use of a simple checklist that boils down to "keep everything really clean." So it's infuriating all over again to read today that a new survey [2] of doctors and nurses suggests that pretty much nothing has changed: [3]Why aren't hospitals leaping to adopt these best practices?.... More than half of the 2,075 respondents, most of whom were infection control nurses employed by hospitals, reported that they use a cumbersome paper-based system for tracking patients' conditions that makes it harder to spot infections in real time. Seven in 10 said they are not given enough time to train other hospital workers on proper procedures. Nearly a third said enforcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the necessary money to prevent CRBSIs.Italics mine. How is it possible that hospital CEOs don't even know about this? We're talking about something that saves lives, costs almost nothing, and would probably reduce healthcare costs by over a billion dollars nationally if it were adopted aggressively. And equally, why is our medical system still so screwed up that doctors routinely treat nurses like serfs who are too cowed to insist on sterile procedures? I mean, talk about the cost of lingering patriarchy. In this case, it might someday kill you.
[Peter] Pronovost said part of the problem was that many hospital chief executives aren't even aware of their institution's bloodstream infection rates,let alone how easily they could bring them down. When hospital leaders decide to create a culture in which preventing infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting catheters, physicians are provided antiseptic soaps as part of their catheter kits and infection control personnel have the best tools to monitor patients.Links:
[1] http://www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande
[2] http://www.apic.org/AM/Template.cfm?Section=Featured_News_and_Events&CONTENTID=15870&TEMPLATE=/CM/ContentDisplay.cfm
[3] http://www.washingtonpost.com/wp-dyn/content/article/2010/07/12/AR2010071204893.html?hpid=topnews
I grew up in the decades when medicine WAS personalized and based on individuality. I also watched it change over time to what I've coined as "Cookie Cutter" medicine back in the 70s.AMA officially supports "personalized medicine"
In a June 15, 2010 release following the annual meeting of its House of Delegates, the American Medical Association noted that the organization now officially supports "personalized medicine as a way to enhance patient care." The release defines personalized medicine (PM) as "health care that is informed by a person's unique clinical, genetic, and environmental information." They continue:"It has long been known that individual patients respond to the same disease and treatments differently, and the goal of PM is to identify these individual differences so that the best treatments and preventions can be used. In order to maximize the benefit of PM, the health care workforce needs ongoing education about the use of genetic technologies in clinical care. Adequate oversight and regulation must be implemented, and coverage of clinically useful PM should be considered by insurers."Comment: Over the last 3 decades, holistic and environmental and naturopathic doctors have argued their distinctiveness from conventional practice in part via responsive to "biochemical individuality" and their provision of "individualized care." This was in opposition to cook-book, reductive, pharma-based protocols that have dominated conventional treatment. Thus, this AMA endorsement seemed notable. Of course, it is also worth adding that it wasn't the individuality of patients as much as the backing of the genetic testing industry that, at this moment in time, brought this endorsement of common sense.
I find it quite strange that the pro-licensing, hybrid-medical naturopaths want you to beleive this is a new concept and something only they know about.
The CAM integrators, trying to hold on to an old idea in medicine will tell you the same as they follow the Newtonian model into a new world where quantum mechanics and string theory rule.
This was the same obstacle I found as a grad student in nursing at an old, Ivy League institution.
And yes institutionalization remains alive and well.
