There are good data showing that the current over-emphasis on “rules” for clinical decision-making is not resulting in improvement in care. While some rules are helpful, even necessary, clinical medicine is too complex and “fuzzy” to rely on them. This is the problem with our current regulatory environment – the belief that medicine can be reduced to a set of instructions, which, if followed, will result in good care. In fact, for all but a few situations, good clinical judgement and experience is what is needed. And that cannot be distilled down to an list or guidelines. It’s hard enough to teach and really must be acquired over years of experience.
There are few areas of medicine in which this is more apparent than pain care. Pain is intrinsically difficult to understand and diagnose. Although the government and insurance industry are trying to simplify this care into a list of rules, it is not working. And people are suffering from the effort. What is needed is to foster interdisciplinary collaboration, help clinicians gain and share experience while keeping an open mind and remaining centered on the individual patient.