A patient when comes in contact with any physician for his or her ailment, he or she expects the best care from the doctor when the same patient visits different doctors they are treated differently.
Some of that difference can be attributed to the expertise and experience of physician or level of training and still some can be attributed to individual’s preference. Other then this we still see vastly different and sometimes conflicting treatments offered to patients. We expect the patients to trust the physicians and the advice given by them at the same time we expect physicians to have the best knowledge and extreme concern about the patient. This is the right of patients on their physicians. Since the community is diverse and the attitude of the physicians cannot be controlled or monitored so the world devised a system to provide a standardized way of treatment to the patients. That is called clinical pathway or the medical pathway and is created to streamline the care of the patients.
The dictionary definition of the medical pathway is
“A description of practices likely to result in favorable outcomes of patients with a particular diagnosis that uses prospectively defined resources to minimize cost. It may be based upon research literature or common practice.”
Another definition of the pathways is
“Standardized interdisciplinary care map for a specific diagnosis related group. Clinical pathway guides a patient’s plan of care through attainment of specific clinical outcomes by the patient from admission to discharge. Benefits of the pathways include increased communication among members of health care team, Standardization of the care, documentation and evaluation tools, decreased cost and length of stay and increased patients and family satisfaction. ”
If we look into the history of clinical pathways we need to appreciate the efforts of NEW ENGLAND MEDICAL CENTER in Boston USA in 1985 where the concept approved, inspired by the work of Karen Zandar and Kathleen Bower. Since then it is continually evolving and now is considered the best tool to achieve a standardized care and good patient satisfaction.
A pathway differs from guideline or protocol in that it is typically a crystallized all encompassing documents dictating the standard of care that the specific patient will receive in the course of the pathway moving forward. It can also serve as a legal document of the defined care that the patient received based upon the best practices or research.
In Pakistan we don’t have a standardized care defined properly that could be used to gauge the level of care provided to the public at large.
We do understand that the system of care is not up to par and there is not enough infrastructure. Yet we do have the responsibility to provide with a defined care pathway based upon the services available. In simple words our patients should know that despite an inadequate health care system the physicians should had done these basics and that document could be used to judge or audit the level of care of the physician. Although it is a work of regulatory body, but can also be taken by reputed institutions like AKHU or Shifa.
Our physicians in training learn entirely different protocols from the book which cannot be implemented in our country and so have tough time balancing the knowledge attained with the ground realities faced by them. In that regard creating and disseminating pathways can serve as an excellent document to be utilized by the physicians to provide the care that is necessary.
I can be reached at erdoc@shifa.com.pk