Protocol, Protocol, Protocol

I have spent over a decade in a variety of intense medical environments – from the battle field to the operating room to the emergency department. Protocols, treatment algorithms, and checklists are put in place to reduce mistakes and bad outcomes. As Atul Gawande shared in his book “Checklist Manifesto”, a simple checklist will protect us from failure. I will admit when I saw the title and heard all the positive chatter, I was not thrilled. Medicine was supposed to be like on TV, like on Gray’s Anatomy or House. We are supposed to be winging it in the unknown at all times, right? 

You would have a very short career for a number of reasons if that was the case. There is certainly empathy, intellect and discretion found in the practice - and this comes from intrinsic morality and experience. But the art of medicine is also something that should be scalable, from the individual to the system. It should be reproducible, unbiased and incorporate pattern recognition and simple tools to help guide it along. At the end of the day, there is no doubt that protocols save lives. 

I spent a few days at the clinic, watching, listening and learning. It was quite a learning curve. They follow their clinical guidelines and they cover the basics and more. Malaria and other tropical diseases can present in a lot of different ways, so I learned a lot about making the right diagnosis. What I thought was a routine backache, was actually a systemic infectious process. I think the fever gave that one away some of the time, but not always. We could all agree on one thing though – and that was who was sick. That is an instinct any good training program will instill in you, and without it you are going to be in trouble.

These are smart clinicians, we quickly recognized that. Our mission does not involve telling people how to do their jobs. We want to help them find ways to optimize the processes and outcomes related to their jobs. We were able to incorporate some of the processes we apply in our clinical settings, and it was beneficial because it added to the systems and knowledge that they already have. We worked with the clinical team to develop checklists for managing these sicker patients, especially the ones who stayed the night. We came up with a process to document important aspects of their care that guides the direction of treatment. They understood the concept of rounding, but we took it to the next level, making it more comprehensive and helpful, so they can track their data. As they continue to grow, take on more patients, and expand facilities, these are the foundations that are going to allow them to do so safely.

We applied step-by step processes across the board – from triage and intake, to trauma and neonatal emergency assessments. And they are running with it. The next step is to incorporate technology to make it easier to store and view.

I learned a lot while I was out there, and I look forward to going back. Hopefully I will be bringing some passionate educators and learners with me to share in the experience. I took away probably much more than what I left. But what I do know is that I saw light bulbs turn on. Seeing those lights flick on sums up my passion as a medical educator. Because I know that these are the basic things that are going to save lives, catch problems, and reduce mistakes. These are the things that are going to make this clinic great.

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