Wallace describes the pace that general practitioners implement new guidelines as 'suboptimal'. A better way to put it might be 'appropriately cautious'. GPs are accustomed to receiving new guidelines on a frequent basis. To read all of them would require us to relinquish our clinical duties and stop seeing the patients to whom we are meant to apply the new guidance.
Prescribing guidance is particularly prone to change. I can remember being advised to prescribe co-amoxiclav by brand because it was cheaper than the generic. The same usually applies to new contraceptive pills when they are released to market.
As for clinical guidelines: they are drawn from studies that involve patients who may share a certain demographic with mine, but they rarely apply to the patient sitting in front of me. (1).
In my experience, slavishly adhering to new guidance does not necessarily improve patient care or relieve human suffering; far more important is to ask the right questions, listen, and take a good history.
1. Does the evidence referenced in NICE guidelines reflect a primary care population? Paul Scullard, Asmaa Abdelhamid, Nick Steel, Nadeem Qureshi. British Journal of General Practice 2011; 61 (584): e112-e117. DOI: 10.3399/bjgp11X561177
Rapid Response:
New guidance does not trump clinical judgment
Wallace describes the pace that general practitioners implement new guidelines as 'suboptimal'. A better way to put it might be 'appropriately cautious'. GPs are accustomed to receiving new guidelines on a frequent basis. To read all of them would require us to relinquish our clinical duties and stop seeing the patients to whom we are meant to apply the new guidance.
Prescribing guidance is particularly prone to change. I can remember being advised to prescribe co-amoxiclav by brand because it was cheaper than the generic. The same usually applies to new contraceptive pills when they are released to market.
As for clinical guidelines: they are drawn from studies that involve patients who may share a certain demographic with mine, but they rarely apply to the patient sitting in front of me. (1).
In my experience, slavishly adhering to new guidance does not necessarily improve patient care or relieve human suffering; far more important is to ask the right questions, listen, and take a good history.
1. Does the evidence referenced in NICE guidelines reflect a primary care population? Paul Scullard, Asmaa Abdelhamid, Nick Steel, Nadeem Qureshi. British Journal of General Practice 2011; 61 (584): e112-e117. DOI: 10.3399/bjgp11X561177
Competing interests: No competing interests