Reinventing the guidelines movement


Category : Medical Rants

I have yet to find a good idea that cannot be ruined. The origins of the guideline movement stem from the evidence based medicine movement. The goal of the original guidelines was to produce guides for frequent problems. These guides used evidence in a systematic way.

AHCPR originally sponsored a series of well developed guidelines. Their participation ended because of politics. The back pain guideline angered spine surgeons and through their lobbying efforts AHCPR was in great danger of disappearing. In fact it was reinvented as AHRQ, but no longer did the government sponsor guideline panels.

Now guidelines are usually sponsored by professional societies. I have written previously about the biases in guideline development. So my first suggestion is to take professional societies and industry sponsorship out of the guideline development process.

Over the next week I will give my opinions on several problems with guidelines. Feel free to add your own opinions – I will try to respond in future entries.

My last thought about guidelines today is that we should not forget that guidelines differ from performance indicators. We should not use guidelines to judge physician performance. Rather we should design and test performance indicators which clearly demonstrate an improvement in patient outcomes. More on that later.

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Comments (2)

The problem with guidelines is that they treat everyone the same. We are all different – current guidelines do not make any allowance for that!

Thank you for reminding us where these guidelines actually come from. It’s a damn shame that politics interfered with the original AHCPR series. I bet many physicians believe that current guidelines are still being developed according to original AHCPR process and standards. When evidence-based medicine steps on too many toes, it seems that politics and economics takes over.

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