Reviews Personal views

Guideline overload forgets the staff needed to implement them

BMJ 2006; 332 doi: (Published 11 May 2006) Cite this as: BMJ 2006;332:1160
  1. Yuen Cheng Looi (, specialist registrar in general internal medicine and geriatrics
  1. Royal Oldham Hospital

    Hurrah! We now have a guideline telling us how to recognise malnutrition in our patients. This brings the total number of national guidelines for UK doctors to 300 or more. Out of interest, I had a quick look on the National Institute for Health and Clinical Excellence (NICE) website. With regards to published articles alone, it listed 95 technology appraisals, 156 guidelines on interventional procedures, 41 clinical and cancer services guidelines, as well as 93 health technology assessment reports. There are 13 ongoing consultations, including one inviting comments or suggestions on redesigning the NICE website.

    We also have guidelines from the General Medical Council, not to mention the National Service Frameworks. Our colleagues in the north have 85 Scottish Intercollegiate Guidelines Network (SIGN) guidelines as well. There are further guidelines from professional bodies and finally, last but not least, European guidelines such as the European Working Time Directive.

    Some basic things are missing in our rush to shunt patients from one place to another

    The point I wish …

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