Preserving Creativity in Medicine

G alvanized by rising costs, increased calls for greater accountability, and an Institute of Medicine (Washington, D. C., United States) report suggesting that medical errors may kill nearly 100,000 Americans every year [1], United States health care experts have tried to boost the quality of patient care by focusing on the speed and precision of service delivery. Several insurance companies have already started to place a surcharge on patients who elect to receive care from " ineffi cient " providers (a defi nition that includes most teaching hospitals), hoping to encourage patients to seek more cost-effective service, and to encourage physicians to provide it [2]. The problem is, most of these reform efforts, while critically important, only capture half the picture. Effi ciency isn't everything, and unless we learn to cultivate creativity as avidly as we pursue consistency, future generations of patients may fi nd themselves stuck with the same basic treatments they're receiving today. It will be the same medicine, just served quickly. From its earliest days, medical training was based on an apprenticeship model, in which junior acolytes learned the art from senior practitioners. Even with the evolution of modern medical schools, which offered future physicians a rigorous common training, once doctors entered the real world they essentially did as they pleased. Consequently, there were pronounced differences in approaches to common problems from one clinician to another. There was also little to guarantee that once doctors had hung out their shingle, they were actually competent (and remained competent) to practice their craft. While most physicians remained committed to the general professional standard—do the best that you can for each individual patient— many well-meaning doctors ultimately were not delivering their patients the best care available. More recently, and largely due to the contagious spread of the so-called " business model, " there has been an increased emphasis on the consistency and quality of care. The clear goal is ensuring that all patients truly receive the very best care available, as defi ned by rigorous scientifi c studies. This discrepancy between what patients should be receiving and what patients are actually receiving is the major focus of quality reform, and refl ects the new recognition that there are truly preferred approaches—pathways—to guide disease management. These pathways are not meant to represent a rigid algorithm refl exively applied to each patient, but are intended as a summary of the best available …