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Do we have too many clinical practice guidelines?

April 20, 2011

Dr Wes equating clinical practice guidelines (CPGs) with the ever-growing tax code

The short answer is: probably. A more complete answer, however, is that we have too many low quality CPGs that are published in unusably long diatribes in all corners of the medical literature. We don’t need fewer CPGs per se, but better guidelines published in a central location in an easy-to-use format.

It has become fashionable to use CPGs as a punching bag. Commenters like to point out that many of the recommendations contained in CPGs are based on lower grade evidence. They are not erroneous in this assertion. But they always fail to ask the next question: why?

The “highest quality” research is derived from multiple randomized, controlled trials answering a narrowly defined question. This is an expensive enterprise, especially if we expect researchers to conduct several trials for each step of the guidelines they develop.

The value of CPGs does not hinge solely on every step within the guideline being proven by multiple randomized trials. This would be ideal, but impractical. The real value of CPGs is in providing clinicians a common and systematic approach to a given disease. It allows a family physician in a rural practice to think like an experienced cardiologist when managing a patient post-MI. Fundamentally, CPGs put everyone on the same page and ensure, to a degree, patients receive the best level of care based on the available evidence.

Instead of spreading the irrational fear that “doctors will soon be behaving less like doctors and more like tax accountants,” we need to be pushing for better evidence–possibly engage ourselves and generate some of the evidence–and demand well organized, easily accessible guidelines.

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