Problems and promises of the protocol
Problems and promises of the protocol
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DOI：
10.1016/s0277-9536(96)00235-3
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发表时间：
1997-04-01
影响因子：
5.4
通讯作者：
Berg, M
中科院分区：
文献类型：
--
作者：
Berg, M
为医疗工作制定协议（或指南、标准）正在成为一项大生意。方案的优点和缺点已被多次重申：倡导者认为方案可以提高护理质量，减少实践中不必要的变化，并可能有助于使医疗实践更加科学。相反，批评者认为，方案将导致食谱医学、技术水平下降以及护理质量下降。在不断重申这些主张的过程中，它们越来越脱离医疗工作以及方案的创建和使用的实际实践。基于对这些实践的实证研究，本文试图重振这一争论。讨论了该协议的四个问题：该协议强化了将医疗行为视为个体的、形式上理性的过程的倾向；该协议助长了人们普遍认为单一答案的错觉；该议定书导致难以解释和/或量化的信息和干预措施的重要性丧失；该协议将导致医疗保健实践日益官僚化和监管。明智地使用协议有几个好处，随后将对此进行讨论：阐明行动方案创建讨论论坛，并将部分决策过程委托给协议可能会导致人员获得新的能力。 (C) 1997 爱思唯尔科学有限公司。
Creating protocols (or guidelines, standards) for medical work is becoming big business. The pros and cons of protocols have been reiterated many times: advocates argue that protocols may enhance the quality of care, reduce unwanted variations in practice, and may help to render medical practice more scientific. Critics, on the contrary, argue that protocols will lead to cookbook medicine, to de-skilling, and to a reduced quality of care. In the continuing reiteration of these claims, they have more and more become removed from the actual practices of medical work and of the creation and use of protocols. Building on empirical research of these practices, this paper attempts to revitalise the debate. Four problems of the protocol are discussed: the protocol reinforces the tendency to perceive and describe medical action as an individual, formally rational process; the protocol contributes to the widespread illusion of the single answer; the protocol contributes to the loss of importance of information and interventions which are difficult to explicate and/or to quantify; and the protocol will lead to an increasing bureaucratisation and regulation of health care practices. Judicious use of protocols has several promises, which are discussed subsequently: explicating a scheme of actions creates a forum for discussion, and delegating parts of the decision-making process to a protocol-may lead to personnel acquiring new competences. (C) 1997 Elsevier Science Ltd.