FINDING OUT BEST PRACTICE.

FINDING OUT BEST PRACTICE. Atul Gutwande tells a story in his article that illustrates what seems to me another gap in medical research. Gutwande tells of how when his son was an infant he suffered a “tiny subdural hematoma—a small area of bleeding in the brain.” Gutwande had seen many cases like this in his own medical training, and the practice was to hold the patient for 24 hours for observation. His child’s doctor wanted to send the infant home after 10 hours. Gutwande “bullied the doctor into admitting him anyway.” The next day the patient was fine. Gutwande checked the textbooks. Either way of doing it was OK. The lesson that Gutwande draws is not that it’s different when you are personally involved with the patient. Gutwande thinks that a doctor treats the patient the way he was trained. Gutwande was trained one way and his son’s doctor was trained another.
Gutwande asks why doctors do things so differently from one place to another. He describes a patient in McAllen Texas and asks how a McAllen doctor is to know whether certain tests are “essential, let alone the best possible treatment for the patient? It isn’t what they are responsible or accountable for.” What he is describing is that there is apparently little collection and analysis of data on how patients are treated—and not just in different parts of the country, but by different doctors. In effect, experiments are being conducted everywhere and nobody is reporting the results. I am led to believe that although there are many infants with subdural hematomas, nobody is collecting data to see which method of treatment works out better.