Variations in Practice

Talking to one of my surgeon friends in the last post reminded me that there's a wide variation in practice. Some surgeries that are routinely done in an open fashion here are done laparoscopically or robotically elsewhere. We are experts in certain procedures that aren't performed at outside hospitals. From a pre-operative standpoint, we don't routinely check pregnancy tests for women in their childbearing years before surgery whereas it is always performed at other places. Our anesthetics differ as well; in Europe, anesthesiologists use laryngeal mask airways for cases that we would normally intubate. There is a wide variation in how to maintain anesthesia, what post-operative pain management entails, which antiemetics are routine. Even in other specialties, there are many approaches to the same clinical scenario, and much of it is institution, culture, or training based.

This is not to say that one practice is better than another. There are certainly standards and guidelines, but most variation in clinical medicine falls within perfectly acceptable norms. This, then, becomes the art of medicine. We tailor our practice to the strengths of our physicians, the expectations of our patients, the review of complex and often conflicting research data and evidence. We make conscious choices in creating the culture and norm at our institution, then tailor specific decision-making to each individual patient. As a result, patients may get different diagnostic tests or treatments at different places, and we understand this can be distressing, especially if patients think there's one right answer or approach. Unfortunately, such variation in practice comes with the uncertainty, complexity, unknowns, and challenges of clinical medicine.