Medical Guidelines and Medical Consensus-I

A climatic change has occurred in the practice of medicine, resulting from the changing economics of healthcare delivery and a new participant mentality. This has been driven by professional organizations and especially the Government. This conceptual shift was accelerated by the Medical Guidelines Movement in the United States in the mid-1980’s when thanks to the emergence of “evidence-based medicine”, a major area of policy focuses on “Outcomes and Effectiveness and Technology Assessment.” Thus was born The Agency for Health Care Policy and Research (AHCPR) who has invited just about everyone from health care organizations to other public- and private-sector entities to submit their clinical practice guidelines for inclusion in the National Guideline ClearinghouseTM (NGC), a comprehensive electronic database.”

In addition to these and other Government-sponsored sites, physicians, health plans, patients, and hospitals are constantly deluged by an archipelago of professional societies and organizations, mostly devoted to their own area of interest, submitting and issuing periodic guidelines and consensus opinions. You’ll be pleasantly surprised by NGC’s very candid disclaimer, though defined in the most compelling Governmental officialese, says in part:

“The NGC database contains evidence-based clinical practice guidelines as defined by the Institute of Medicine (IOM):

    “Clinical practice guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” (Sounds groundbreaking, doesn’t it?, but hang on.)

These guidelines are not fixed protocols that must be followed, but are intended for health care professionals and providers to consider. (My emphasis) If you require more reassurance, see the Federal Register, the final word on Governmental regulations having legal effect. Federal Register (CFR Vol. 63 no. 70) officially defines Clinical Practice Guidelines, but publishes not a single guideline.Should We Worry?

Most consensus policies are still achieved by selection of expert panels or organizations whose opinions conform to each other. Far too many professionals, HMO’s, and other healthcare organizations, even sophisticated patients, are eager to follow the latest schematic orthodoxy, whether it be the “standard” for treating advanced cancer, or the decision to perform invasive studies. These standards, described as “Medical Guidelines” are often far from uniform or consistent.

More tomorrow…

Leave a Reply