November 1977


Author Affiliations

From the Division of Hematology-Oncology, Scripps Clinic and Research Foundation, La Jolla, Calif.

Arch Intern Med. 1977;137(11):1595-1596. doi:10.1001/archinte.1977.03630230071017

It is fortunate that medical training can prepare us to do certain things without each time having to unravel the "why" of what we do. In most situations, our timesaving, comfortable Standard Operating Procedures (SOP) provide the best available procedures, rational decisions for stereotyped problems, decisions based on experiment, and experience in which the risk-benefit ratio is to the patients' benefit. In most people, habitual behavior and habitual set-of-mind are impossible to alter without a perceived and valuable incentive. In the practice of medicine, this inner stability is reinforced by codes of ethics, governmental ukase, standards of practice customary in the community, and the "Catch 22" implicit in Good Samaritan situations. When we have followed to the letter some SOP and things have turned out badly we can, if we think of it, take comfort from the assurance that we practice by the book.

However, the authority of the book,

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