Doctors should give up some of their independence and help develop evidence-based guidelines and protocols if they want to make headway against mistakes, a Johns Hopkins physician contends.

“It’s been almost 10 years since the Institute of Medicine published ‘To Err Is Human,’ yet we really haven’t made much progress,” Peter J. Pronovost, MD, PhD, charges (JAMA. 2008;300:2913-2915).

According to his analysis, hospitalized adults receive recommended therapy about 55% of the time. For children, the rate is 47%. The shortfalls reflected in these statistics are partly to blame for the 98,000 Americans who die each year because of hospital error, the critical-care specialist asserts.

“Imagine,” he says. “America has some of the best doctors and medicine in the world, yet we are getting it right only half of the time.”


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Dr. Pronovost proposes a three-pronged approach to improvement:

Physicians should participate in a team-oriented approach to medicine and stop viewing themselves as lone guns. Dr. Pronovost sees modern medicine as a complex, high-risk organization, like nuclear power plants and aviation, in which teamwork, checklists, and standard procedures get the job done safely and efficiently. “Team-based standardized-care protocols will give physicians more time to spend on difficult cases” that do not respond to usual care, he predicts.

Medical students and residents should be trained in this interdisciplinary approach. “They should understand that outcomes are a product of systems and tools designed to deliver care,” he writes, not the result of autonomous physician decisions.

Evidence-based protocols should be developed in a transparent process that includes all stakeholders—patients, physicians, methodologists, regulators, and payers. Biases and uncertainties about risks, benefits, and costs for patients, clinicians, and payers should be made explicit. “When done well, standards and checklists can help improve the quality and reduce the costs of care and enhance rather than compromise the profession of medicine,” he maintains.

“Gone are the days when a doctor was on his own, carrying all the tools of modern medicine in a black leather bag,” Dr. Pronovost says. “Today, much of care is team-based, and the wealth of techniques and wisdom is too much for one doctor to keep in his or her head. Standardization and a move away from physician autonomy will help guarantee that each patient receives the best treatment available.”