RIGHT PATH G iven the strong current of rugged individualism that always has run through American culture, it’s not surprising that we, as healthcare consumers, want, and expect, treatment plans that are tailored to our unique biology and circumstances. But is purely personalized care always the best medicine? Despite strong evidence on the benefits of cholesterol- lowering statin medications for patients with certain cardiovascular-disease risk factors, there is considerable variation in which patients are prescribed the drugs — with physician preferences and geography often carrying more weight than data from large randomized controlled trials, which are considered the gold standard for clinical research. Similarly, the research is unequivocal on the benefits of administering certain antibiotics at key points before specific operations, yet it isn’t always done. And if the evidence points to the value of colonoscopy screening in normal-risk patients beginning at age 50, we don’t expect our doctor to decide on a case-by-case basis whether or not to recommend it. In other words, even as many people like to romanticize medicine as something of an art, in which decisions about treatment are made creatively and individually, that is not really what we want in cases where the science clearly points to a single approach as most effective. Then, we’d prefer to go by the book. “Intuitively, we want care that is patient-specific. But in reality, patients are much-more similar than they are different,” says Tom Rosenthal, MD, chief administrative officer for UCLA Health. “When care is purely individualized, we find a lot of variation that isn’t explainable by the evidence and isn’t in the patient’s best interest.” In addition, there is “variation that is not based on necessity and therefore arguably wasteful. By standardizing the appropriate aspects of care and setting up processes to ensure that they are delivered reliably, we reduce that random variation. In so doing, we improve quality while reducing cost.” Standardization makes for a more-consistent product, adds Samuel A. Skootsky, MD (RES ’82, FEL ’83), chief medical officer of the UCLA Faculty Practice and Medical Group, which oversees the outpatient practices of UCLA Health. That, “almost by definition, means higher quality. Particularly when patients are engaged to help define the standardized-care pathways, it’s more likely to result in the outcomes that they want,” he says. Although evidence points to the need for more standardization as a way to improve the safety and efficiency of care, no one is advocating a checklist approach to all aspects of medicine: Some individual physician discretion will always have its place. Moreover, Dr. Skootsky is quick to point out that within most standardized pathways, there will be exceptions. “A particular patient may come along for whom the standardized approach is not in his or her best interest,” he says. “In such cases, you can’t be dogmatic. Instead, it’s an opportunity to learn, then see if this is a situation that should be built into the approach for the future.” U MAGAZINE 27