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EditorialEditorials

Do Clinical Guidelines Still Make Sense? No

Ross E.G. Upshur
The Annals of Family Medicine May 2014, 12 (3) 202-203; DOI: https://doi.org/10.1370/afm.1654
Ross E.G. Upshur
Department of Family and Community Medicine, University of Toronto, Ontario, Canada
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  • For correspondence: ross.upshur@gmail.com
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  • Vies de Publicacao, e Genetica [Publication Bias and Genetics]
    Francisco Vilaca Lopes
    Published on: 29 August 2014
  • Utility of Clinical Guidelines
    Carl Knopke
    Published on: 20 May 2014
  • Published on: (29 August 2014)
    Page navigation anchor for Vies de Publicacao, e Genetica [Publication Bias and Genetics]
    Vies de Publicacao, e Genetica [Publication Bias and Genetics]
    • Francisco Vilaca Lopes, Medico Interno de Medicina Geral e Familiar

    Muito obrigado por este assunto que e tao relevante para a medicina geral de hoje.

    Penso que as linhas de orientacao tem ainda mais defeitos do que os referidos: ha muitos ensaios clinicos que nao foram publicados, e como tal nao podem influenciar as recomendacoes; e a heterogeneidade dos doentes em clinica geral nao se refere apenas as doencas e patologias que eles possuem, mas tambem a diferente genetica das pop...

    Show More

    Muito obrigado por este assunto que e tao relevante para a medicina geral de hoje.

    Penso que as linhas de orientacao tem ainda mais defeitos do que os referidos: ha muitos ensaios clinicos que nao foram publicados, e como tal nao podem influenciar as recomendacoes; e a heterogeneidade dos doentes em clinica geral nao se refere apenas as doencas e patologias que eles possuem, mas tambem a diferente genetica das populacoes humanas neste planeta, heterogeneidade que certamente influencia diferentes etiologias para a mesma apresentacao clinica e diferentes respostas a um mesmo tratamento para uma mesma patologia.

    Muito obrigado por esta discussao!

    [English translation:
    Thank you for this subject that is so relevant to general practice today.
    I think the guidelines have even more defects than those referred to: there are many clinical trials that are not published, and as such cannot influence the recommendations; and the heterogeneity of patients in general practice not only refers to the diseases and conditions that they have, but also the different genetics of human populations on this planet, heterogeneity that certainly influences different etiologies for the same clinical presentation and different responses to the same treatment for the same pathology.
    Thank you for this discussion!]

    Competing interests: None declared

    Show Less
    Competing Interests: None declared.
  • Published on: (20 May 2014)
    Page navigation anchor for Utility of Clinical Guidelines
    Utility of Clinical Guidelines
    • Carl Knopke, Physician

    I agree that clinical guidelines are not relevant due to the great heterogeneity of the patient populations that we are faced with. Given adequate education and resources, clinical guidelines could be used by a provider to adapt to a particular patient.

    The problem is that clinical guidelines are increasingly seen by insurance companies and regulators as rigid and in this way they are not useful. It seems th...

    Show More

    I agree that clinical guidelines are not relevant due to the great heterogeneity of the patient populations that we are faced with. Given adequate education and resources, clinical guidelines could be used by a provider to adapt to a particular patient.

    The problem is that clinical guidelines are increasingly seen by insurance companies and regulators as rigid and in this way they are not useful. It seems that guidelines have outlived their purpose as "guidelines" since there no longer seems to be any discretion provided to physicians.

    To properly use a guideline that has discretion for how much a provider may or may not use the guideline, there is increased need for a provider to be aware of the given research on a topic. This needed extra research seems to undermine the utility of a guideline where a one size fits all model can be applied. This also undermines the idea that any given physician who uses a guideline can be a generalist and speaks more to the need to be a specialist.

    This is an excellent topic for Family Medicine and I hope that our leaders in Family Medicine can see how guidelines are undermining our very purpose.

    Competing interests: ?? None declared

    Show Less
    Competing Interests: None declared.
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In this issue

The Annals of Family Medicine: 12 (3)
The Annals of Family Medicine: 12 (3)
Vol. 12, Issue 3
May/June 2014
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Do Clinical Guidelines Still Make Sense? No
Ross E.G. Upshur
The Annals of Family Medicine May 2014, 12 (3) 202-203; DOI: 10.1370/afm.1654

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Do Clinical Guidelines Still Make Sense? No
Ross E.G. Upshur
The Annals of Family Medicine May 2014, 12 (3) 202-203; DOI: 10.1370/afm.1654
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