Blog | Monday, November 6, 2017

The responsibility to prioritize


Each day when we work with patients, we prioritize their concerns, their diseases, and their economic situation. Our patients often have great complexity and we cannot address every problem during at one time. We must prioritize their problems and address the most urgent, perhaps spending less energy on the least urgent.

But who determines urgency; who determines priorities? Too often computer pop-ups direct priorities. Too often we are urged to turn our attention to an algorithm-defined priority rather than a patient-defined priority. So, the first need for prioritization comes in our responsibility to the individual patient.

Another situation for prioritization comes in guideline development. Have you tried to absorb any guidelines recently? Many guidelines are inordinately long, and almost never prioritized.

Studies of guidelines show that around half of all guidelines have insufficient evidence, thus they are really expert opinions. Why cannot we have guidelines prioritized so that we practicing physicians can clearly read the high priority guidelines that have strong evidence and only read the less important parts of guidelines if we have a particular interest in that disease or problem?

We easily become overwhelmed in medicine. Without prioritization, patient care can be overwhelming. We should learn to understand which problems or potential problems stimulate the greatest concern. We should be able to sort through guidelines and learn about the most important recommendations.

We have to sort through much patient information and much medical literature information. Only through prioritization can we deliver the best care for our patients.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.