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REVIEWS: M Werner Can medical decisions be standardized? Should they be? Clin Chem 1993; 39: 1361-1368 [Abstract] [PDF]

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Paradigm shift

JW Sharp   (6 November 2001)

Paradigm shift 6 November 2001
JW Sharp, Physician Vassar Brothers Hospital Send letter to journal: Re: Paradigm shift JWSPATHCO{at}aol.com JW Sharp	Dr. Werner has correctly identified the shortcomings of clinical practice guidelines. They do not work because they focus on the provider instead of the patient—the fundamental healthcare unit. The amount of variance contributed or associated with the patient, for any medical procedure, technique, or process swamps the variance contributed by the physician. For any medical procedure, the difference between the best and worst provider is measured in inches, while the difference between the best and poorest patient candidate for that procedure is measured in miles. Simply stated medicine is all about patient selection. Poor patient selection yields poor outcomes regardless of what expert-based practice guideline the physician follows. Why then is the lion's share of regulatory process directed at the doctor? Until we recognize the importance of patient selection there is no reason to expect healthcare to improve.