Thread by @OBsleepmerchant

#SolShnider track begins with Dr Tiffany Angelo introducing @bscottsegal to start the protocolization in #OBAnes debate vs @HansSviggum at #SOAPAM2023

@bscottsegal will lead off with the PRO argument for protocolization in #OBAnes #SOAPAM2023

The early years - ICU is where it started, treating critically ill patients (no #OBAnes yet) #SOAPAM2023

Okay evidence in ICU and #AnyAnes in @NEJM #SOAPAM2023

More ICU… @SOAPHQ #OBCCMSIG still tuning in, but at risk of losing the pure #OBAnes #SOAPAM2023

11 years ago @bscottsegal would have stopped here. However, things have moved forward. Protocolized GDM care decrease morbidity, improved fetal outcomes. #SOAPAM2023

Just being included in a @cmqcc bundle made a difference. Protocolized oxytocin administration has improved outcomes. But what about the personalized #OBAnes care we could provide? #SOAPAM2023

Personalized care is not sliced bread. It’s either future, fantasy or fraud. Genetic testing takes too long. Some significant other concerns or challenges.
#SOAPAM2023

AI can deal with big numbers but some big concerns. Objections: Can’t protocolize everything, cookbook medicine, skill loss.
A reminder that best chefs keep cookbooks close to start them thinking rather than replace thinking (@Nigella_Lawson may or may not confirm - @GongGasGirl… twitter.com/i/web/status/1…

@HansSviggum starts the CON side of the debate. #SOAPAM2023

How do we treat 2 disparate patients the same way? Scotch sounds like a difficult character. “There is one best way” is an erroneous assumption. Protocols don’t answer every question. #SOAPAM2023

Do protocols work? Maybe, occasionally, minority. Adherence is important. >2000 years we have known that treating patient is more important than the disease. #SOAPAM2023

We are not able to use genetics (yet) #SOAPAM2023

Protocols remove the patient from the equation. Some times individual choice makes a difference. #SOAPAM2023

Changing protocols is “exciting”. Vince Lombardi (football coach): keep it simple, focus on basics. Personalized care has to actually be “personalized”. Goodhart’s Law. #SOAPAM2023

And @HansSviggum wraps up the CON argument. Good protocols are rare and need to be living documents. Put patient at centre of care. Cannot assume the protocol will save you.
#SOAPAM2023