The Nefarious Strength of Average

Talking to a very intelligent colleague, I learned an absolute truth: "the system tends to pull you towards the average". The dialogue was about whether or not to follow international guidelines in emergency care. It is common to talk about "the real world" and the "world of books". After 20 years of training and working hard in the real world, I am sure that an evil fog begins to distance us from what is right, from what is a protocol established by serious studies, with large populations that respect the statistical rigor necessary to save lives and avoid harm thinking about individuality and collective health. Something so difficult that it can only be learned in a college that lasts 6 years full-time and that requires 4 to 6 years of specialization after graduating in a modality called "medical residency", such as the time we spend in the hospital, that is, we live there. This is so that we can assist the largest number of patients and perform as many procedures as possible. For what? In order not to let anyone suffer beyond reason for being sick or even to not lose his life.

The issue arose because, in a given health care institution, some protocols were no longer being followed due to the lack of technical skills of the labor involved. Procedures established in international guidelines are no longer followed because the team does not have the technical conditions and / or the ability to do so. This reminds me of two other sayings: "a lie told several times becomes true" and "nonsense said by many becomes law". I think it would be better to train the disabled team. Simulate exhaust procedures so that they can be conducted safely. No, the option is to stop following the protocols and do what you can to "save your life". Let's face it, we are not on a battlefield in Afghanistan.

It is unfortunate to see well-established protocols and guidelines being thrown in the trash in favor of what facilitates the life of the institutions, not worrying about the collective good. If I don't know how to do it, instead of training to learn I don't do it and I still manage who my partner is and decrees the following: "since we don't know how to do it, we won't do it". And there is more, who follows the protocol and does the procedures is that he starts to be seen as outlier, almost crazy.

In light of all that is available in technology and training and simulation systems, I cannot accept such a return to darkness. I pray that my older colleagues and, especially, the younger ones do not let the system pull them to the average. So that they seek excellence not only remuneration. So that they are able to explain to their patients why a certain procedure or treatment is necessary, providing adequate and individualized tools so that the patient can help in the decision.

Nothing creates more anxiety and errors in emergency care than insecurity. I repeat the old example of airplane pilots. They simulate all the time and need to be certified periodically so that they can practice their profession. If our medical and nursing councils do not charge us for this, that our conscience covers us, before something more powerful does.

Image: healthcare-in-europe.com

Author: Aline Friedrichs de Souza - Pediatrician and Pediatric Gastroenterologist