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Conflicting asthma guidelines cause confusion in primary care

BMJ 2018; 360 doi: (Published 09 January 2018) Cite this as: BMJ 2018;360:k29

Trump card: "The NICE guidelines said"

I understand clinicians' concern of having two national guidelines which give conflicting recommendations.<1> However, is this incident a wake-up call that today clinicians are too dependent on guidelines?

"The NICE guidelines said..." This is probably the trump card used whenever clinicians want to defend their judgement. But when you inquire about the rationale and evidence behind the guidelines, some clinicians can suddenly become speechless. They do not always try to learn the reasons behind the recommendations. Some recommendations can simply be opinion-based, because no better evidence is available.

Even if randomised-controlled trials and systematic reviews are available, the guidelines extrapolate these data to apply to the general population. Clinicians must understand that the clinical context of each patient is unique, and can make certain guidelines inapplicable. This makes clinicians irreplaceable, because they can apply clinical evidence, along with their patients' history, examination and investigation findings, to determine the management plans and which guidelines to follow.

Perhaps, it is time for clinicians to put their critical thinking caps on, rather than solely regurgitating guidelines. Or else, the NHS could replace clinicians with printers which reproduce guidelines, and have laymen to blindly follow the guidelines. That would be a bad cost-saving strategy that hinders patient care.<2>

After all, many clinicians learned evidence-based medicine and critical analysis during their training. There are reasons why these topics are in their school curriculum.

1. Keeley D, Baxter N. Conflicting asthma guidelines cause confusion in primary care. BMJ. 2018;360:k29.
2. Rimmer A. Spend more on NHS or see services deteriorate further, hospital leaders warn. BMJ. 2018;360:k175.

Competing interests: No competing interests

12 January 2018
Eugene Y.H. Yeung
Medical Doctor
Royal Lancaster Infirmary
Ashton Road, Lancaster, LA1 4RP, UK