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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