The Executive Suite: The roast and the pan: Implications for healthcare

Neil Baum, MD

One day after school, a young girl noticed that her mom was cutting off the ends of a pot roast before putting it in the oven to cook for dinner. She had seen her mom do this many times before but had never asked her why. She asked, and her mom said, "I don't know why I cut the ends off, but it's what my mom always did. Why don't you ask your Grandma?"

So, the young girl asked her grandmother, and Grandma said, "I don't know. That's just the way my mom always cooked it. Why don't you ask her? The young girl called her great grandmother, who was living in a nursing home and asked her the same question, and she replied, "I cut off the ends of the pot roast because that's what my mother did." And she did not say it because it makes the meat juicier. She said, "When I was first married, we had a tiny oven, and the pot roast didn't fit in the oven unless I cut the ends off." Or, in other words, she said that's how we do it here, which was passed down for nearly three generations.

What are examples of using too small a pan for your roast in your practice?

Having been in practice for more than 40 years, I have witnessed several areas where we tend to behave and perform actions and behavior on our patients just like they've been done before.

Example 1. Treatment of uncomplicated UTI (no fever, chills, or flank pain) with a 7–10 day course of antibiotics. Studies have clearly shown that a short course of antibiotic therapy, i.e., 1-3 days, is just as effective in eradicating symptoms with fewer side effects than the longer course of treatment.

Example 2. Symptomatic treatment of URI without antibiotics. Since 1946 when Dr. Benjamin Spock wrote his book on childcare, Dr. Benjamin Spock's Baby and Child Care, hundreds of thousands of pediatric patients have received antibiotics for a viral infection. It wasn't until the 1990s that it was appropriate to counsel parents that most URIs are viral infections and self-limiting and require only symptomatic treatment and not antibiotics.

Example 3. For several decades most physicians allocated 15-minutes for each patient. This was the standard operating procedure for most offices. Now it is more efficient to identify the reason the patient is coming to the office and schedule a time that is most appropriate for that visit. For example, if a patient is coming to check their blood pressure and blood cholesterol level, that visit is approximately 5-minutes. However, if a patient is coming for a new visit to discuss the result of a biopsy that revealed cancer, then 30 minutes might be more appropriate.

Here's my question or request for the readers of this blog: do we need to swab the antecubital space with alcohol before phlebotomy? I advocate that unless a patient is immune-compromised or using chronic steroid medication, wiping the skin with alcohol, which burns and increases the pain associated with phlebotomy, then alcohol is not a requirement. I was interested in performing a study with patients receiving an alcohol swab before phlebotomy vs. a saline\sterile water swab and comparing the pain and erythema or any other adverse events when only saline or water cleansed the skin before phlebotomy. I know this is a minor issue, but it serves as an example of using old-fashioned methods or a too-small pan for the roast placed in the oven. It would be nice for multiple practices to look at this antiquated tradition and demonstrate that this is an example of a roast too big for the proverbial pan used for centuries. Anyone interested in pursuing this study, please let me hear from you.

Bottom Line: Every practice has archaic methods and procedures being performed or conducted in our practices and on our patients that need to be modified or even removed. We don't have to look very far to identify those roasts that don't fit the roast pan. I agree that sometimes they are small changes, but more significant improvements will soon follow when you start with minor changes. I am eager to hear from your opinions or comments. (doctorwhiz@gmail.com)