A Physician Examines Clinical Pathways

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Stick to pathways or use them as guidance? A physician explores.



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In American medicine today, “variation” has become a dirty word. Variation in the treatment of a medical condition is associated with wastefulness, lack of evidence and even capricious care. To minimize variation, insurers and medical specialty societies have banded together to produce a dizzying array of treatment guidelines for everything from to , from to .

At some level, this makes sense. Some types of variation are unwarranted, even deadly. For example, we know that ACE inhibitor drugs improve quality of life and survival in heart-failure patients, but only two-thirds of American physicians prescribe these drugs to such patients. A study by the National Committee for Quality Assurance, a nonprofit organization focused on health care, reported that 57,000 Americans die each year because the care they get is not based on the best available evidence.

Complete article in The New York Times: