In medicine, there is not a “one size fits all” answer to every problem. A clinician should be ready to face the process of trial and error, as much as it is unsettling. Patients don’t always read the textbooks and there is an art to practicing medicine. So, a clinician must be ready to face the uncertainty of clinical outcomes and pivot because not every management plan is perfect.
The Complexity of Clinical Outcomes in Pediatrics
In pediatrics, a very common and very routine illness is an ear infection, otitis media. Once diagnosed, kids are commonly placed on antibiotics. However, not every child responds exactly to the plan. Some kids continue to have an ear infection despite the initial antibiotic treatment and require changing the antibiotic because of concern for a resistant organism. Some kids may have a reaction to the antibiotic that warrants a change in the medication as well. Other kids may suffer recurrent and repeated ear infections that necessitate the placement of tubes in the ear drum (tympanostomy tubes) to prevent recurrent ear infections in the future. While the treatment for otitis media is fairly standardized, the outcome is not always predictable.
The same is true in pediatric critical care medicine. Some children may develop an overwhelming infection of the body called sepsis. Sepsis has a treatment algorithm that outlines what to if a child does not respond to the initial management. It is a complex illness that can affect multiple organs in the body to varying degrees. Not every child will respond to conventional treatments and, unfortunately, some children don’t respond to any treatments. We can’t always predict why one child responds well and why another child doesn’t. We follow the management algorithm, but there is a constant reassessment and refining of what treatment is provided.
Quality Improvement in Individual Patient Management
The reassessment and refining process that we undertake is a common methodology that we use in quality improvement projects. While we encounter these quality improvement projects throughout the medical community, most of these take the form of macro-scale projects aimed at solving systems problems. However, these principles can be applied to the individual management of patients as well. The plan, do, study, and act cycle is applicable under any circumstance where one is evaluating the effectiveness of an intervention.
Embracing Uncertainty
Interventions in medicine demand that we reflect on the results and consider how we can improve our efforts. In medicine, every clinician must be ready to face the uncertainty of clinical outcomes and pivot when a plan does not result in the expected result. There are so many complexities in medicine and so many variables that make each patient unique. While medical interventions may be standardized, patient outcomes are not, and clinicians and patients must realize that the process of trial and error is not only normal but necessary to ensure the best outcomes for patients.
In your opinion, how can clinicians effectively communicate with patients and their families about the potential trial and error process with medical management and still instill confidence in them about the treatment plan?
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