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Problems and promises of the protocol

M Berg1

  • 1Department of Health Ethics and Philosophy, Maastricht University, The Netherlands.

Social Science & Medicine (1982)
|April 1, 1997
PubMed
Summary
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Medical protocols offer potential benefits like improved care quality but also risks such as de-skilling and over-regulation. Careful implementation is key to harnessing their advantages while mitigating drawbacks in healthcare practices.

Area of Science:

  • Healthcare Management
  • Medical Ethics
  • Health Services Research

Background:

  • The creation and implementation of medical protocols (guidelines, standards) are increasingly prevalent in healthcare.
  • Existing debates on protocols highlight potential benefits (enhanced quality, reduced variation) and drawbacks (cookbook medicine, de-skilling).
  • Current discourse on protocols often lacks grounding in the practical realities of their creation and use.

Purpose of the Study:

  • To revitalize the debate surrounding medical protocols by grounding it in empirical research.
  • To critically examine the practical implications and challenges associated with the development and application of medical protocols.
  • To explore both the potential pitfalls and promising aspects of protocol utilization in medical work.

Main Methods:

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  • Empirical research into the actual practices of medical work concerning protocol creation and usage.
  • Analysis of the theoretical and practical problems arising from protocol implementation.
  • Discussion of the potential benefits of judicious protocol use.

Main Results:

  • Protocols can reinforce a view of medical action as a purely individual, rational process.
  • They may foster an illusion of singular correct answers, overlooking nuanced clinical situations.
  • Protocols risk devaluing non-quantifiable information and lead to increased healthcare bureaucratization.
  • Conversely, protocols can facilitate discussion and enable staff to develop new competencies through delegated decision-making.

Conclusions:

  • While protocols present challenges like oversimplification and bureaucratization, their judicious use can foster dialogue and professional development.
  • Re-evaluating protocol design and implementation is crucial to maximize benefits and minimize negative impacts on healthcare quality and practice.
  • A balanced approach is needed to leverage protocols effectively without compromising clinical judgment or essential aspects of medical practice.