Cook Book Medicine

The CEO of Medco, the pharmacy benefits manager has no tolerance for physicians who say they are above "cook book medicine".

This guy doesn't get it.  Cook book medicine is but a tiny fraction of care.  Perhaps 5% or less.  I can admit a hemorrhagic stroke, follow standardized protocols and the next 10 patients will have 10 different permutations of care.    I can follow the guidelines to a tee and every single patient's comorbid conditions will add layers upon layers of complication to the management.  You can't write a protocol for patients, only diseases.  Perhaps Dave Snow would like to tell Mrs Smith that her coronary artery disease is not allowed to flair during her pneumonia admission.  The protocol doesn't account for that.   Or perhaps Mrs Smith is not allowed to get delirious during her heart failure exacerbation.  The protocol can't account for it.  Or perhaps the acute massive GI bleed.  Or maybe 1000's of possible permutations of management that aren't protocol driven.

What you want is a robot.  What we have are patients.  Tissue does not listen to logic.  No matter how many protocols you write.  They are called guidelines for a reason.  

Thinking that medicine is a series of protocols makes you look silly.  Really silly.  The only way this guy would get it would be to follow a doctor, any doctor for a week.  Do nothing but go on rounds with that doc.  Then spout off about how easy it is to connect P to Q.  

How one becomes a CEO of anything (except perhaps banks and mortgage companies) with such poor insight is beyond me.  Maybe everyone around him is blind as well.