As pediatricians, we treat hundreds of sick children every year, from those with earaches to those with cancer. Some of our small patients are among the most vulnerable, whose parents rely on Medicaid for their treatment.

Our patients and their parents trust us to keep their care our No. 1 priority. They know we will relieve their suffering, promote their health and do no harm.

We were thrilled, therefore, to learn early this year that Gov. Chris Gregoire had launched an initiative to fix our state’s ailing health system through an evidence-based approach to care: The “gold standard” when it comes to patient treatment.

By ensuring that every patient gets appropriate treatment the first time, we will improve patient care while cutting costs down the line, even if that sometimes means spending a little more up front, as the governor said, “to get the quality needed.” This is the sane and medically sound approach that our young patients need.

But something has gone wrong.

A budget provision presented to the Legislature emphasizes cost over quality.

It also displays a misunderstanding of what true evidence-based health care entails.

We, our 600 colleagues in the Washington Chapter of the American Academy of Pediatrics and the 9,000 other physicians of the Washington State Medical Association, implore the governor to help us achieve cost savings by providing each patient high-quality medical care, not by controlling medical decisions.

The state’s Medicaid department has requested resources to hire more people to prevent physicians’ “inappropriate and off-label use of certain prescription drugs.” They also seek to punish physicians who have “demonstrated substandard practice patterns.”

On their faces, these are laudable goals. However, they represent an oversimplification of medical practice and may end up jeopardizing, not safeguarding, some already vulnerable patients.

Prescribing drugs “off-label” (that is, other than for their FDA-approved use) has become the science-based approved standard of care for many diseases.

For example, when treating premature babies, who require aggressive care, doctors regularly use these drugs to save these tiny patients’ lives. More than 90 percent of newborn babies who require intensive care receive at least one off-label medicine during their hospital stay as an essential part of their treatment.

Over 60 percent of children with cancer will need a life-saving off-label treatment.

Rigorous clinical trials on many drugs used off-label provide hard, scientific evidence for their efficacy in treating a broad range of conditions. The FDA requires truckloads of paperwork to move a drug from “off-label” to “approved for this age,” an impossible bar for many of our treatments and our patients.

While we applaud the department’s efforts to assure appropriate and cost-effective use of medical services, and to deal with truly aberrant behavior, this program expansion uses a sledgehammer when a laser scalpel is needed. We are willing to help the governor and the Department of Social and Health Services do the delicate surgery needed to provide good, safe and effective care to our patients.

We physicians welcome clinical guidelines. As medicine becomes more complex, guidelines offer unbiased scientific conclusions about which treatments work best for most people and provide physicians with a good starting point in the medical decision-making process.

But guidelines apply to the average patient, not to every patient. Mandating that physicians deliver medical care exclusively according to guidelines makes the assumption that all people are round pegs that fit into the same hole. You want your physician to treat you as an individual.

Will doctors have exhibited “substandard practice patterns” if they treat a patient outside of guideline parameters when necessary to provide appropriate care? Will all pediatricians be punished when we use off-label medications every day for the healing of our patients?

For patients to receive effective treatment, physicians must use guidelines plus their training, experience and professional judgment to determine if care that works for most people is appropriate for the particular biology and personal circumstances of the patient sitting in front of them, or if another treatment is required. That’s what evidence-based health care is all about.

That is the approach the Institute of Medicine advocates to ensure that each patient receives appropriate care.

That is the approach we use when treating our patients every day over a combined practice experience of 50 years.

That is the approach we hope our governor will back by rejecting “decision control.”

We ask Gov. Gregoire to champion her bold initiative by supporting quality care for each individual as the real way to make health care in Washington work.