cookie cutter medicine

Canadian Medical Association Creates Clinical Decision Rules on When to Use Clinical Decision Rules

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ALBERTA, CANADA – After the Annual General Meeting of the Canadian Medical Association this summer, a majority motion is pushing a new initiative to produce a new set of Clinical Decision Rules to govern the use of Clinical Decision Rules.

cookie cutter medicine
Cookie-cutter medicine

Dr. Jared Herzbinger of the CMA believes these rules will be a gamechanger for Canadian physicians.

“Up until this point, doctors across Canada have had to use clinical judgment in deciding when they should use clinical judgment and when they should rely on a set of prescribed algorithms to determine what course of diagnostic or therapeutic action to take.  With these new rules, we hope to make things even more straightforward.”

The new clinical decision rules which are expected to be released by January 2016 would encompass conditions from heart disease to minor injuries to obstetrical emergencies and everything in between.

Dr. Herzbinger unfurled what appeared to be a giant map onto the table.  He then guided GomerBlog through an example: “There has been some concern regarding how these would be implemented.  It’s really quite simple.  You join the algorithm at the relevant stage for your patient.  For example, if your patient Bob Smith has pain, you can already hop in at the top of the algorithm.  Then it guides you down different paths depending on where the pain is.”

“Turns out his pain is in his head so you go down that path of the algorithm.  Is it recent onset?  Okay.  Has it been traumatic?  Okay, continue following the decision rules.  So after we found out that Mr. Smith has pain, in his head, from a traumatic injury.  After following the pathway you can see quite clearly that we can now use the Canadian CT Head Rules to determine whether or not he needs a CT of his head.  No more guessing as to whether or not the CT Head Rules should be used for a traumatic head injury!  It’s totally clear!”

Not all Canadian physicians are impressed.  Dr. Holly Mills, an endocrinologist in Vancouver seems to think this will further muddy the waters of patient care.

“I know there is a big push for evidence-based medicine, but this is a big risk to doctors everywhere.  I would normally just use my years of experience and clinical judgment to know when a set of decision rules would apply.  Now I’m afraid that if I don’t follow the new Clinical Decision Rules and forget a step, I might get sued.”

Dr. Herzbinger responded via email.  “We are taking our member’s concerns very seriously. To help our members get acquainted with the new Decision Rules, we’re building an app for it.  It was closely modeled after a similar successful project known as WebMD.”

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