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Protocol is not only for the queen…

October 30, 2012

Another post in the “more is not better” category.  This one comes from close to home, and I’m sure my parents will forgive my using them as examples.  A protocol in medicine is a set of rules/guidelines for how to deal with specific stituations.  There are protocols for everything, from what to do if a patient falls to the steps to take before surgery to rules about who can drive you home from the hospital to what treatment you need for meningitis, etc.  Everything has one.  My parents, who are generally healthy, ran into three of them.

So this guy in his 70s has been having GI symptoms, diarrhea, etc. for a couple of days, then gets chest pain radiating down his left arm, so he goes to the ER.  EKG looks ok, enzymes negative, stress test is equivocal so he gets a cardiac catheterization to look at his coronaries.  His coronaries are fine.  His cholesterol is normal.  So they send him home.  On Cipro, Flagyl, and Lipitor.  Why the drugs?  Well they didn’t know what the diarrhea was about and they didn’t check for everything so they put him on Cipro and Flagyl just in case.  In case of what?  He’s a healthy guy coming from the community.  Flagyl (metronidazole) is given for amoebic dysentery, abscesses, post-operative infections from colorectal surgery.  Cipro (ciprofloxacin) is what they give you if you get montezumas revenge in India.  He didn’t need those.  He got them because thats the “diarrhea protocol”.  And the liptor?  Well he came in with chest pain so discharge protocol says you go home on a cholesterol lowering agent.

A woman in her 70s comes to the ER with Atrial fibrillation.  They give her some drugs, she goes back to normal rhythm.  They send her home right?  Nope.  She has to sit in the hospital for 12 hours.  Why?  To make sure she stays in sinus rhythm.  Why 12 hours?  No particular reason.  It’s a random number.  It’s the protocol for atrial fibrillation.

Protocols are in place to standardize things so nothing gets missed.  This sounds like a good idea. But remember what I’ve said before in this blog: medicine is not an exact science, and no patient is standard.  If you are discharged from the hospital with a whole raft of new medications, or if you have been sitting in the hospital for unclear reasons, please ask.  Or get your advocate to ask. There may be good reasons. Or you may be a protocol victim.

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