Talk:Guideline (medical)

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There are real problems with guidelines, I put the following points as an initial aide to adding a suitable section. Its poorly worded and verbose, but serves to raise some issues. I gladly would welcome any comments, so that I might have a better first-stab at adding an appropriate section to the article.

• Relevency
  • Who draws up the Guideline eg
    • Hospital consultants may have a poor understanding of the realities of General Practice
    • Health Services, such as the NHS, have an interest in treating the many & not necessarily the interest of a specific patient (either low-effective but cost-effective eg pesuading a patient with mild raised cholesterol to start treatment, or high-effect poor-cost-effectiveness such a very expensive treatment for a rare condition).
  • How is the Guideline updated with new research and studies contributing to the evidence base.
• Application - 'Guideline', as the name suggests is to 'Guide' but how much is this then compulsorily imposed upon doctors by health services.
  • Over or under offer of treatment
    • If Doctors are paid 'Quality points' for following guidelines, will they force patients into treatment and drugs without the patients true informed-consent.
    • Conversely will doctors deny treatment because of absence from Guideline as having poor evidence base, or disliked by Guideline writers, when other options not appropriate and the patient may be one of the small number who would benefit from the treatment.
  • Inappropriateness - A patient's dignity requires non-essential treatments to be withdrawn if they are terminally ill. So continuing to give cholesterol treatment to a patient terminally ill from cancer is not going to improve their 10year heart-disease risk. Yet to stop treatment risks the doctor's performance to appear poor.
• Liability
  • If a guideline is produced, but not followed by the doctor and harm befalls the patient, then there is a risk of legal redress being sought:
    • If there are several guidelines on the same topic coming from different sources, then which one does the doctor select and which are rejected (the accusation then moves from ability to follow a guideline to ability to select a guideline). One General Practice in the UK at one point drew up a Guideline of which Guidelines they would accept; the rest, being unsoliceted by the practice were returned to the sender with a copy of the Practice's Guideline explaining the rejection !
    • If the doctor rejects a guideline proposal as being a flawed interpretation of the evidence (eg statins may reduce cholesterol and improve life expectancy after a heart attack, but a person aged 103 is never going to gain extra years of life) or that the degree of benefit outweights non-measureable quality of life issues (eg terminally ill patient with pmildly-poor diabetic control shouldl not be switched from tablets to insulin injections whetehr or not they have a needle-phobia, they are never going to develop 10-years risks of kidney, neurological or retinal complications from sub-optimal diabetic control.
  • If the patient wishes to demand treatment on a Guideline that a Doctor feels is not justified, then where is the support for the Doctor's professionalism (we do not want Doctors to be mindeless administrators ticking through a checklist)

Of course 'Guideline' is more flexible than evidence-based-medicines initial use of inflexible 'Protocols' - David Ruben 21:12, 8 August 2005 (UTC)

[edit] Article title and possible duplicate articles

• The opening sentence says that clinical protocol is a synonym, but there is a separate article called clinical protocol. Should they be merged? There is also a scrappy medical protocol article that looks to me that it should redirect to this article.
• This article should be renamed. It is preferable to use a noun in parentheses rather than an adjective (see Wikipedia:Disambiguation#Topic_page_naming. I would prefer Medical guideline over Guideline (medicine), unless something like "Medical protocol" would be more appropriate. I don't know enough about the topic(s). Nurg 06:32, 13 November 2005 (UTC)

A protocol is not a guideline. Protocols are more concise and typically have more of a local and binding character than guidelines. JFW | T@lk 13:00, 13 November 2005 (UTC)

• • Indeed: protocol & guidelines are separate, but the articles do need improving and discussion of their pros & cons includes comments I made above (and will eventually get round to adding in), which highlight the important differences David Ruben 03:34, 14 November 2005 (UTC)