Time to reinvent the guideline movement
When most physicians consider guidelines, they envision standards for managing medical problems. The term – guidelines - gives the impression of authority. Those who write guidelines seem to write as if they represent authority. Researchers castigate physicians for not following guidelines. Payers reward physicians who follow guidelines.
But guidelines are not authoritative rather they are guides developed to inform care not to direct care.
This article on pharyngitis guidelines clearly provides a description of the problems of guidelines. Adult pharyngitis seems, at first consideration, a straight forward and simple clinical complaint. Yet, for several reasons, Dr. Matthys and colleagues found minimal agreement amongst 10 separate guidelines for diagnosing and treating adult sore throats.
This article should invalidate the myth that guidelines are merely an extension of evidence based medicine. First, the 10 guideline groups did not agree on which articles to include in developing their guideline. More important, these guidelines demonstrate that all guideline committees start with implicit biases.
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The truth about guidelines is that they are molded though the value structure of the panel members.
R Alanko MD
October 8th, 2007 / 12:34 am
Excellent article, thanks for pointing it out!
I also appreciate your comments. Guidelines oft seem to substitute an expert panel’s bias for my own.