Dr Derek Raghavan Addresses the Concept of "Cookbook Medicine"

While clinicians can have a bad reaction to the idea of “cookbook medicine,” it can really result in patients getting the best treatment, said Derek Raghavan, MD, PhD, FACP, FRACP, president, Carolinas HealthCare System's Levine Cancer Institute.

Transcript

Implementing evidence-based guidelines can be viewed as “cookbook medicine.” Is the concept of what cookbook medicine means and can do changing?

The phrase “cookbook medicine” is sort of an unhappy one because it triggers reactions, particularly among clinicians who like to individualize care. And they make it seem like the creativity of medicine is going out the window. My own feeling is, if you use the term “cookbook medicine,” simply to relate to a concept where you have structured evidence with the best level of clinical trial data that has been looked at by both leaders in the medical community and isolated clinicians to ensure that whatever the “recipe” is can be implemented well, then I think that has to lead to better medicine.

It’s pretty much the same as true cooking. You’ll have the most brilliant culinary chef who has days when his creativity just doesn’t work. Hopefully, the best of the chefs actually, are using the tricks that they’ve used again, and again successfully. Every now and then an experiment in the kitchen fails abysmally and if it happens to be at a major function, it’s catastrophic for the cook. From the medicine analogy, when you make a mistake it’s much more catastrophic for the patient.

So, today, patients have the right to expect the best treatment, the cheapest treatment, based on the evidence that’s available that has been published by independent clinicians, not necessarily people with a conflict of interest. Once you develop guidelines that are predicated on level 1 evidence with people who don’t have skin in the game and that have been reviewed independently, patients are likely to get better results.