Unwarranted variations in healthcare delivery: implications for academic medical centres

In my opinion, one of the primary barriers to the implementation of
evidence based guidelines (thereby narrowing the gap in healthcare
delivery), which has been hinted at in another response, is the incredible
degree of arrogance possessed by not a few of my physician colleagues.

Expert knowledge/clinical guidelines have been distilled for many diseases
and are disseminated through a variety of mediums, only to be shrugged off
by many physicians. When attempting to have some physicians follow
expert, evidence based pharmacotherapy guidelines for a given disease,
some reply: "I don't need anyone to tell me how to treat my patients" or
"I hate cookbook medicine". I'm afraid that we have far too many of the
proverbial 800 pound gorillas who do what they want, how they want, when
they want. For the present this type of behaviour is tolerated and
defended vehemently, although with the looming financial healthcare crisis
I believe that the parties paying the bills (insurance/government) will
demand that proven therapies be consistently applied. It may take
governmental/legal pressure to bring some of us (at least in the United
States) to the painful conclusion that, yes, sometimes others do know how
to treat patients better than we do.

Competing interests:  
None declared