What should clinicians do when faced with conflicting recommendations?

doi:10.1136/bmj.a2530

Published 28 November 2008, doi:10.1136/bmj.a2530
Cite this as: BMJ 2008;337:a2530

Editorials

What should clinicians do when faced with conflicting recommendations?

Find guidelines that are systematic and transparent, and makeinformed judgments

The first 150 words of the full text of this article appear below.

Clinical practice guidelines sometimes make conflicting recommendations.¹² ³ ⁴ ⁵ ⁶ ⁷ ⁸ For example, a sore throat may be managed differentlyin North America, France, and Finland—where guidelinesrecommend that a diagnostic test should be performed and thattreatment should be conditional on its result—than itwould be in England, Scotland, the Netherlands, and Belgium—whereguidelines recommend that the decision to prescribe penicillinshould depend mainly on the severity of symptoms, with no testing.¹

Such disagreements occur for both valid and non-valid reasons.Valid reasons include honest differences in the many judgmentsthat go into a recommendation—judgments about which researchis relevant; the risk of bias in that research; the applicabilityof the research findings to the question at hand; and the relativeimportance of the anticipated benefits, adverse effects, andcosts. Non-valid reasons include conflicts of interest, lackof awareness of relevant evidence or ignoring such evidence,failure to appraise the relevant research critically, . . . [Full text of this article]

Andrew D Oxman, researcher¹, Paul Glasziou, professor of evidence based medicine², John W Williams, Jr, professor of medicine³

¹ Norwegian Knowledge Centre for the Health Services, PO Box 7004, N-0130 Oslo, Norway, ² Department of Primary Health Care, University of Oxford, Oxford OX3 7LF, ³ Center for Clinical Health Policy Research, Duke University and Durham Veterans Administration Medical Center, Durham, NC, 277 05, USA

oxman@online.no

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