I was asked recently to write a treatment algorithm for publication in a specialty throw-away journal. It was harder and took much longer than I expected and in the end, I didn’t like doing it. Because I don’t think I like algorithms.
I hate to think that what we docs do, all that prodding and questioning and examining, the critical thinking and diagnostic accumen, can really be distilled down into a one page diagram with boxes and circles and arrows. There’s just so much more to the practice of medicine than following a pathway.
I was going to say it feels like cookbook medicine, and then I stopped and thought about what the term really means. And I imagined that chefs feel the same way about recipes that I feel about algorithms.
After all, a recipe is just a list of ingredients with instructions on how they are to be combined. It does not tell you how the meat feels when it is done, or how long to beat an egg white so it is stiff without being dry, or how to roll out a pie crust. Those things come with experience, with training and with a love of cooking.
So following a recipe does not make one a great cook, anymore than following an algorithm makes a great doctor.
I bet meat and pie dough and all are generally more fully cooperative and less frightened and worried than people, eh? (Well, maybe not pie dough… pie dough could be a high maintenance sort of person.)
Pushing this analogy could get messy quickly…
I think that’s a great analogy, TBTAM. Thoughtful post.
Regards
jmb
It is a great analogy. All the way down to “You have to know the basic ingredients and techniques cold before the nuances mean a thing.”
Curious to know what the difference is between not to follow an algorithm and when to follow one. Seems to me that I hear more often than not terms like “protocol”, “regimen”, “standard treatment”.
Clearly the use of algorithms in medicine is pervasive, so when does the algorithm go away, and the science-based thinking from the individual doc come to play?
I live in a semi-rural area north of Philadelphia. Unfortunately, I have found a fear by the local docs to break protocol and keep the patient without just sending them to a specialist. I think these docs would LOVE that someone like TBTAM authors an algorithm.
Perhaps TBTAM’s reluctance to living under an algorithm is a telling sign of the high-quality, good-science based care she provides to her patients…they are lucky to have her.
Nicely put! I once worked at a medical school and would love to see this one-size-does-not-fit-all approach to medicine become part of the curriculum. Your patients are lucky – and so are the people who get to eat your yummy food!