A guide on guidelines
A well known definition of guideline was provided by the Institute of Medicine: "Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances."1 So, in these day and age, can family physicians practise good medicine without following clinical practice guidelines (CPG)? This interesting question was debated by two authors in a recent issue of Can Fam Physician. Upshur has persuasively argued that we can.2 He highlighted the problems of undifferentiated illness where guidelines do not exist, difficulty of applying evidence in patients with multiple clinical problems, and contraditory recommendations from guidelines on the same topic. In a rebuttal, Gass argued that guideline can be an efficient summary of best practice and is very helpful to the busy practitioners.3 Both authors have their points; CPG is a useful aid in clinical practice, but conscientious family physicians need to assess the suitability of the clinical evidence contain in CPG for his or her patient. In the absence of CPG to guide practice, we may have to fall back on our clinical judgement, or if time permitting, conduct a more thorough search of the publish literature for guidance. (copied from article).
Field MJ, Lohr KN (Eds). Clinical Practice Guidelines: Directions for a New Program. Institute of Medicine, Washington, DC: National Academy Press, 1990. http://download.nap.edu/cart/download.cgi?&record_id=1626&free=1.
Upshur REG. Can family physicians practise good medicine without following clinical practice guidelines? YES. Can Fam Physician. 2010;56(6):518-20. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902930/pdf/0560518.pdf.
Gass D. Can Fam Physician. Can family physicians practise good medicine without following clinical practice guidelines? NO. 2010;56(6):519-21. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902931/pdf/0560519.pdf.