Programmes, guidelines, and protocols: the antithesis of precision medicine?

Editor—Columb and Hopkins have confirmed that protocolization is associated with improved outcomes (and that the mechanism of this association is unclear), but economic aspects of protocolization are relatively unexplored. I hypothesize that it will enable the same number of doctors to look after more patients than they can at present, with a corresponding decrease in cost per patient. The suggestion in the editorial that protocolization is necessarily the antithesis of personalized care is awidespread misconception. Complex protocolized care delivered by staff who are not medically qualified and are relatively junior is perfectly possible, but it will require the use of computers to store the protocols and to communicate the steps to the relevant staff at the right time. There is an urgent need for tools for this purpose, but as far as I know none is being developed.