Tuesday, May 13, 2008

Healthy skepticism about practice guidelines

If you didn’t read DB’s rants carefully you might get the idea he was somehow against practice guidelines. That wouldn’t be accurate. There’s a difference between skepticism and cynicism. A Grand Rounds presentation he delivered on the topic at UC Davis puts his rants into perspective. Here are some of my take home messages from the talk:

Guideline developers have conflicts of interest. This is not unique to those supported by drug companies. Virtually all organizations and individuals involved in guideline development---governments, professional societies and individuals interested in their academic careers---have a stake.

Guidelines are not immutable rules and are no substitute for clinical judgment.

You can’t apply all guideline recommendations to patients with multiple complex problems---you must prioritize treatments.

Guidelines can provide impetus for ill conceived performance measures.

There’s much more. Follow the link above and watch the video. It’ll make you think.

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