There Are NO Best Practices


I have been fortunate to be a part of several healthcare organizations across the US. I have also had the privilege of working on such projects as the NCCCP-NCI (website) to focus on bringing Academic Medical Center expertise in oncology care to the community practice.

In many of my conversations with healthcare professionals, one of the first questions I am always asked is: Do you have any best practices to share? Can you point me to a best practice that I can adopt?

Last night I had a conversation with one of my colleagues and friends and the topic of productivity came up. We happened to be discussing how current departments of the hospital use RVU’s (relative value units) to establish productivity goals and metrics. Many hospitals use RVU’s to justify the staffing levels for departments.

My colleague brought up the point that as more and more billable events (CPT codes) are bundled together, that it impacts the RVU’s assigned. Thus, the same procedure which may have shown that it takes 3 people to perform the task, may now be put together, and in calculating the math, may indicate that it only takes 1 person to accomplish the task. (This may be a slight stretch, but it indicates the point)

My response was, “Another prime example of leadership and the healthcare community trying to adopt a best practice.”Screen Shot 2014-12-18 at 4.24.54 PMScreen Shot 2014-12-18 at 4.26.05 PM

Which made me think of the wonderful conversation during #HCLDR this week, and my exchange with Gonzalo (@bacigalupe)

We need to realize that healthcare may want to drive to standardization, decrease variability, and a one size fits most—humans do not act in that manner.

So even though a “best practice” may work well in Boston doesn’t not mean that it can be adopted in Billings. A model that works in Florida doesn’t mean that it translates and will work in Oklahoma. We can take frameworks from programs, key insights from users, and understand what challenges were incurred, but we can not simply plug and play from one community to another.

Healthcare isn’t a hard drive. It’s not an iPhone.

Healthcare is human. Humans are individuals.


As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek


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4 responses to “There Are NO Best Practices

  1. There is a wide variability in the treatments given to patients with renal cell carcinoma, i.e., kidney cancer. It should come as no surprise. Many doctors who attempt to treat it do so when they have little or NO experience with such patients, the various medications and the management of side effects or of other types of treatment. This variability comes from surgeons–who fail to recommend monitoring or to see an oncologist, from urologists–who suggest “watching” tumors when they could be removed, and oncologists–who take patients off effective medications due to the expected side effects!

    The guidelines are there, and though they can be inadequate for some complex cases, the patient who is not monitored properly, thinking his surgeon “got it all” or that there is “nothing more to be done” pays a tremendous price.

    Patients need to ask their doctors how many active cases of this or that disease they handle, what the outcomes are, and what other specialists might have a role to play. Endless stories of return of disease, or worse, due to lack of appropriate and available care.

    • Completely agree with you. Stories and comments such as yours are what helps to educate the masses on what to do, how to do it, and when to ask questions. We need to continue to broadcast.

      • Re our need to “continue to broadcast”, I wonder what way you think is most effective. In my blog, I try to educate the patient while providing an article or resource that he can take to the doctor, perhaps opening the conversation with, “Dr. Expert at MD Anderson or Mayo Clinic discusses a situation which seems similar to mine, and wonder how this might apply directly to our plan of action”. If the doctor does not indicate a willingness to listen and discuss this in a logical fashion, the patient then knows that he is with the wrong doctor. But why should this be necessary?

        Every patient should be given a print out of the basic professional guidelines developed around his/her diagnosis, and get a description of how the planned treatment may or may not fit. Naturally, not every one will fit this approach, but it would give some BASIS for discussing the expectations that both the doctor and patient can use as the disease progresses, the medication takes effect, the patient reacts and so on.

        What a lovely dream, vs being part of a grand guessing game!

  2. I similar conversation about evidence based practices. From the mental health perspective, Anthony Salerno ( argues that it is not about having an evidence based practice, it is about being an evidence based practitioner. Great presentation to think about treatment being individualized.

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