Intended for healthcare professionals

Views & Reviews Personal View

Guidelines can require me to recommend care that I think is wrong

BMJ 2015; 351 doi: (Published 17 December 2015) Cite this as: BMJ 2015;351:h6713
  1. Andrew Spooner, general practitioner, Grosvenor Medical Centre, Crewe CW1 3HB
  1. andrewspooner{at}

Rigid adherence to rules diminishes doctors’ and patients’ autonomy

The King’s Fund said in 2012, “Many doctors aspire to excellence in diagnosing disease. Far fewer, unfortunately, aspire to the same standards of excellence in diagnosing patients’ preferences for their care.”1

I am a GP in a small town. I am besieged by process based rules in the form of guidance from the National Institute for Health and Care Excellence (NICE), professional bodies, specialist colleagues, pharmacy advisers, and many others.

Fear of criticism by authority

I went into medicine as a successful person. During my career I’ve aspired to improve the care I provide and also the healthcare system. I have felt successful at this: I see myself as doing a good job for the patient, and clinical interactions with “my” patients are an important part of how I feel about myself.

Reports of litigation, communications from medical defence societies, and stories of missed cancer diagnoses lead to the fear that …

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