I recently received an email from the medical director of a company a client works for.
It’s a reminder that they’re required to treat a common medical problem using the guidelines. The moral authority for the “one size fits all” approach behind the requirement is cited as the general good.
Guidelines.
The instructions given are bereft of compassion, of discernment, and of art. There is no wiggle room, only “if A then B.” And the punishment for deviation is clear.
You can use DNA to individualize treatment plans down to the milligram, but you can’t use relationship, instinct, intuition, to do the same thing.
The medical director is reflecting his boss’ deepest desire—that he could replace his clinicians with artificial intelligence, an artificial intelligence that could spit out the desired treatment plan in a way that would please his customers and lower his costs.
The technology’s not there yet, but you’re the next best thing.
And if you work for a corporation who’s not treating you like a partner, then subtly and slowly, in a million little different ways, you’re being managed into their version of AI.
You’re losing the engagement, the art, the discernment that cost you so dear to acquire.
Pretty soon, you won’t be comfortable practicing medicine out on your own at all, without all the “support tools.”
You’ll forget that what you offer is relationship, connection, curation, discernment—and that all the “quality scores” and “guidelines” are just ways for others to leverage your gifts for their own profit.
It’s a prison being built for you, brick-by-brick. One for which you soon will not have a key.
Here’s that memo, just in case you don’t see enough of them:
(Corporate medicine organization) has published guidelines for both adult sinusitis and pediatric sinusitis. Most sinus infections are viral and do not warrant antibiotic therapy. Even bacterial sinusitis is usually a self-limited infection and may not require antibiotic treatment.
(Corporate medicine organization) strongly supports prudent antibiotic stewardship. Talk with patients about the benefits AND risks of antibiotic therapy before and when prescribing.
As you might expect, antibiotic therapy is rarely warranted for acute bacterial sinusitis without at least one of these three clinical scenarios:
- Persistent illness – nasal discharge, daytime cough, or both, lasting more than 10 days, without improvement;
- Worsening symptoms – worsening, or new onset, nasal discharge, daytime cough, or fever, following initial improvement;
- Severe onset – fever of at least 102.2 degrees Fahrenheit (39 degrees Celsius) AND purulent nasal discharge for at least three consecutive days.
(corporate medicine organization) expects its providers to document in the medical record the presence of one of these three clinical scenarios in detail, when prescribing antibiotics for acute bacterial sinusitis. We appreciate your continuing efforts in this regard.
For patients without penicillin allergy, amoxicillin-clavulanate is the first-line antibiotic therapy for acute bacterial sinusitis, if antibiotic therapy is indicated. The duration of therapy generally recommended is 7 days. Macrolide antibiotics, including azithromycin (Zithromax, Z-Pak), are NOT appropriate therapy for acute bacterial sinusitis.
In penicillin-allergic patients, doxycycline (cannot be used in children) or levofloxacin can be considered.
Please review the clinical guidelines on the (corporate medicine organization) provider website for alternative therapies, second-line therapies, and therapies in penicillin-allergic patients, patients aged 65 and older, and other special clinical circumstances. Antihistamines, oral decongestants, and systemic corticosteroids are not recommended in the treatment of sinusitis. Nasal corticosteroids can be considered when it is thought that an allergic rhinitis component may be present.