My descent into guideline fatigue syndrome (GFS)

It started slowly.  My former resident and present colleague, Terry Shaneyfelt first authored Are Guidelines Following Guidelines? The Methodological Quality of Clinical Practice Guidelines in the Peer-Reviewed Medical Literature This paper alerted us to the problem.  But guideline fever continued to rage.  Almost every specialty and subspecialty society decided that they needed to join the guideline movement.  They needed to tell us the RIGHT way to practice medicine. While I understood the problems of guidelines (I had found a 40 page guideline on cerumen), it had not yet become visceral.  Then the great pharyngitis controversy of the early 21st century made it personal.  In 2001 the ACP (endorsed by the CDC and AAFP) published Principles of Appropriate Antibiotic Use for Acute Pharyngitis in Adults This guideline endorsed the Centor score to exclude testing or treatment for 0 and 1, test 2, and either test or treat with narrow spectrum antibiotics 3 or 4.  The IDSA the next year published Practice Guidelines for the Diagnosis and Management of Group A Streptococcal Pharyngitis  That guideline argued for testing 2-4 (again neither testing nor treating 0 or 1.  Some authors of that guideline then published an editorial that “took the ACP to task” for suggesting empiric treatment of some patients. We must conclude, therefore, that the algorithm based strategy proposed in the ACP-ASIM Guideline would result in the administration of antimicrobial treatment ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs