Are protocols prescriptive or just recommended?

Traditionally, a protocol will represent a document of agreement between governments, perhaps a prelude to a treaty; or some similar statement intended as a guide to conduct or understanding. (A strictly legal interpretation is not relevant for this post.)

I have discovered relatively recently that medicos have protocols too. A urologist told a patient that it is protocol for a colonoscopy to be carried out only every 4 years. (Colonoscopy is neither a nice experience nor a subject for a casual discourse.)

This specialist was told that, as a pre-cancerous polyp had already been discovered and destroyed twice, 4 years apart, there might be a substantial risk of a cancerous growth during the third and fourth years; and that 2-yearly inspections might be safer. To date, 4 such polyps have been found, 4 years apart, on a 2-year inspection cycle!

Then there are the protocols recommended by pharmaceutical companies, surely to be followed by the medical profession judiciously. However, 2 of my experiences have led me to question my medicos whenever they refer to the protocols of manufacturers as somehow binding upon them.

My intervention in the first case led to an eminent specialist withdrawing his recommend treatment for a condition that he expected the patient to develop; and for the prescribing medico (G.P.) not to increase the dosage of a medication annually (thus ignoring the manufacturer’s protocol). The severe accumulating physical and mental trauma suffered by the patient was thus eventually reversed. A maintenance dosage was all that was required.

In the second case, the patient suffered a psychotic episode all night, after the dosage of a medication had been doubled by a specialist. This specialist had rung the pharmacist to do that, but without seeing the patient, because of (guess what?) the manufacturer’s protocol! Even the G.P. had not been told. Again, my intervention brought a reversal of treatment – and mental peace for the patient.

Medicos are only human, with only some focusing on their self-importance. Respect for medicos can be maintained when there is an open dialogue between patient and practitioner, without any blind intrusion of a protocol.