Guidelines – a major problem

Guidelines are wonderful; guidelines are dangerous.  Over the past decade I have thought often about the benefits and the problems. The first concept that attracted my attention was reading about conflicting guidelines.  Given the same data, different guideline committees would have significantly different recommendations.  At the least this problem raises questions about guideline validity.  It makes clear that committee perspective could influence recommendations.  Guideline recommendations sometimes are clear and demonstrably evidence based, but too often recommendations reflect the committee’s view of the problem. The pharyngitis guidelines represent a perfect example.  Matthys wrote a very important paper in 2007 – Differences among international pharyngitis guidelines:  not just academic. The paper’s last paragraph defines part of the problem: National guidelines on acute sore throat promote different clinical approaches, recommend different treatments, and cite different evidence. There is no evidence that regional variation is appropriate. Introduction of an explicit guideline development method for both European and North American guidelines may lead to more uniformity in the diagnosis and management of acute sore throat. But this article does not even reflect what I consider the biggest problem – diagnostic criteria. When we consider the pharyngitis guidelines (or the sinusitis guidelines for example), we read how to consider the patie...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs