Invited commentary

Abstract

In the past decade, business interests and government policy makers undertook to “refine” the delivery of health care by proposing guidelines that would codify aspects of patient care delivery. The proposed impetus was to improve quality and decrease costs for treating conditions like congestive heart failure, surgical infections, and vascular surgery-related myocardial infarction. The assumption implicit to these guidelines was that physicians and the health care systems they participate in were not interested in or able to improve health care with data-driven strategies. The club of reimbursement was used to drive these quality initiatives, implying that physician concern for the welfare of their patients was not adequate to achieve good results. The excellent article by Goodney et al1Goodney P.P. Eldrup-Jorgensen J. Nolan B.W. Bertges D.J. Likosky D.S. Cronenwett J.L. A regional quality improvement effort to increase beta blocker administration before vascular surgery.J Vasc Surg. 2011; 53: 1316-1328Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar highlights two very important points to remember and publicize as we go forward in the debate on health care reform. The first is that intelligent, well-trained physicians are better able to care for their patients than are committees who believe they have a “special ability” to understand “evidence-based medicine.” Physicians learn early in their training to read the literature with a critical eye and to determine how best to apply new science to their patients. Mandated guidelines are only as good as the data they are based on. They are not able to accommodate specific patient needs, nor are they nimble enough to adapt to new data the way individual physicians do daily. The guidelines urging beta-blockers for vascular patients are a great example of how rushing to “standardize” care pre-empted the wisdom of facts gained through multiple subsequent, well-designed studies and analyses. Medicine may seem to change glacially at times, but I believe this reflects a careful and ongoing critical analysis by physicians of “new science” rather than ignorance or indifference to patient welfare. We practice evidence-based medicine daily. Unfortunately, the evidence is often not as straightforward as the media and pundits would purport. The second important point in this report is that physicians, convinced that a new therapy or approach is in their patients' best interest, will adopt it. The physicians in this research consortium quickly and effectively instituted beta-blocker use, expecting to improve their patients' care. This occurred without financial incentives. I commend the authors for their scientific contribution on the role of beta-blockers in vascular surgery. I also thank them for affirming what I believe about our profession. As a group, physicians, with our speciality societies, will do what is best for our patients. We do not need “Big Brother” herding us to achieve this. We are our patients' best advocates and we must resist the efforts of politicians, lawyers, business interests, and insurance vendors to convince society otherwise. A regional quality improvement effort to increase beta blocker administration before vascular surgeryJournal of Vascular SurgeryVol. 53Issue 5PreviewTo determine if a regional quality improvement effort can increase beta-blocker utilization prior to vascular surgery and decrease the incidence of postoperative myocardial infarction (POMI). Full-Text PDF Open Archive