Blog | Wednesday, September 12, 2012

Foreseeing problems with standardization


Another problem with implementing health care standardization on a large scale is that there's no possible way of judging empirically whether it will all work. (Standardization is the question here.

Other issues are easier. For example, I think it's uncontroversial at this point that expanding healthcare access will save lives.) Neither is there an experimental design which could test the question. We basically have to take it on faith that checklists will scale up to entire health care systems.

Is there a way to foresee problems when large systematic change like this is undertaken, in any field, not just medicine? I am asking you, dear readers, because it's frankly something I haven't looked into much. Did anyone say, wait a minute, we shouldn't construct a huge network of interstate highways? Or: let's think a minute before we build and test an atomic bomb?

There are instances where people did stand athwart history and yell Stop. Iraq comes to mind. But political change, war and peace, seems different, more reactive, than systematic change which we try to initiate on an a priori basis.

Of course, I don't think health care standardization is per se dangerous. I just think, per my previous post, that much of what's worthwhile in health care is not currently quantified. Not unquantifiable as I said before, but currently understudied. Do we know enough about what will be left behind if we move forward under our current, imperfect assumptions about quality?

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.