Over the past few years, a number of resources–guidelines, algorithms, recommendations–have proliferated to support the delivery of high-value care. This is necessary, however it is not sufficient to result in real sustainable changes. This is because largely the gap is not about knowledge of what to do, but rather related to the prevailing influence of medical culture that surrounds each of us. In other words, we know what we should be doing, but the cultures in many of our organizations don’t promote or encourage this.
The current prevailing culture in medicine contributes to widespread overuse. For example, a survey study showed that 97% of emergency medicine physicians report they order unnecessary advanced imaging tests (CTs and MRIs), not because they do not recognize they are unnecessary, but rather mostly due to a cultural response to uncertainty1–just as we saw in the “story from the frontlines” video.
“Influence of Institutional Culture and Policies on Do-Not-Resuscitate Decision Making at the End of Life”
Institutional culture and policies seem to affect whether medical trainees feel compelled to offer the choice of resuscitation in all clinical situations regardless of whether they believe it is clinically appropriate.
Dzeng E, Colaianni A, Roland M, et al. JAMA Internal Medicine. 2015 May;175(5):812-819.
“Most anthropologists would define culture as the shared set of (implicit and explicit) values, ideas, concepts, and rules of behavior that allow a social group to function and perpetuate itself.”6
Culture is simply “the way we do things around here” – Lundy & Cowling, 19967
Despite “culture” having what could seem like a diffuse, or squishy, definition, it turns out that aspects of culture can be defined, measured, tracked, and intervened upon. This will be explored in the coming sections.
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