Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Protocol Problems

 
David Konig writes a must read response to a question Twittered by Steve Whitehead.

When is it OK to deviate from your established written protocols?

While I do not use Twitter, I can answer this in less than 140 characters.
 

Deviation from protocol is not just acceptable, but mandatory, when the protocol is wrong for the patient.
 

The answer to the question does not identify the problem.

The problem is that the patient is not now, nor ever has been, the priority in patient care. That needs to change.

At one end, there are too many of us who are afraid to say when the protocol is wrong for the patient, or to do what is right for the patient, when it is obvious – when we are faced with a real patient.

At the other end, we have QA/QI/CYA people and medical directors more interested in whether protocol observance has been documented, than whether there is actually appropriate care being delivered to patients.

I have received more criticism for doing the right thing than I have received praise for doing the right thing.

I have received more criticism for doing the right thing than I have received criticism for any of the wrong things I have done.

In EMS, as in everything else, we seem to want to live as if the following quote is some sort of rule to live by.
 

Worldly wisdom teaches that it is better for reputation to fail conventionally than to succeed unconventionally.John Maynard Keynes.[1]

 

This is a rule to kill by.

We would rather kill a patient by following the protocol, than do what is right for the patient, if it means deviating from the protocol.

Too many of us are putting going along to get along ahead of patient care.

Maybe we need to encourage the malpractice attorneys to go after bad care, rather than protocol deviation, or gold standard deviation.

We need to get rid of the people who think that critical judgment is a bad thing.

We need to get rid of the people who think that critical judgment can be replaced by protocols.

We spend too much time worrying about appearances, while we kill our patients.
 

Elsewhere, this problem is described this way. There are a lot of officers who will risk their lives for their country, but there are damned few who will risk their careers.
 

Footnotes:
 

[1] There is an interesting discussion of the quote in Independent Cacophony.
 

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