Guidelines should consider clinicians’ time needed to treat
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2022-072953 (Published 03 January 2023) Cite this as: BMJ 2023;380:e072953
- Minna Johansson, director1,
- Gordon Guyatt, distinguished professor2,
- Victor Montori, professor3
- 1Global Center for Sustainable Healthcare, School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- 2Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
- 3Knowledge and Evaluation Research Unit, Mayo Clinic, USA
- Correspondence to: M Johansson minna.johansson@vgregion.se
Clinical practice guidelines aim to contribute to efficient and high quality care.1 Efforts are already made to overcome barriers to implementation such as lack of credibility because of financial or intellectual conflicts of interests, and clinicians’ inability to change habits or keep up to date with new recommendations. However, what is rarely acknowledged is that implementing guidelines may require appreciable clinician time and therefore have considerable opportunity costs in the clinical encounter. Including an assessment of time needed to implement might alter the recommendations of guideline committees and help clinicians to prioritise.
Squeezed time
Several studies have shown the impossibility of meeting all guideline recommendations. For example, a simulation study applying all guidelines for preventive care, chronic disease care, and acute care to a panel of 2500 adults representative of the US population estimated that US primary care physicians would require up to 27 hours a working day to implement (and document) all applicable guidelines.2 To fully satisfy only the recommendations from the US Preventive Services Task Force would require 7.4 hours a day.3
Similarly, to implement the European hypertension guidelines in Norwegian adults, Norway would need more general practitioners than are currently in practice.4 And in the UK, implementing all lifestyle interventions recommended by the National Institute for Health and Care Excellence (NICE) may require more physicians (from all specialties) and more nurses than currently available, according to our estimates (unpublished data). Furthermore, healthcare policies also need to account for the time clinicians should spend listening in silence, noticing carefully, and co-creating sensible plans of care with patients.5 If clinicians followed all pertinent guidelines, there would be no time left to …
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