9 responses to “Guidelines”

  1. Therapeutics initiative finally provided me with the evidence that I saw happening in my practice. I learned the hard way adopting drugs too soon caused trouble. In my case it was ponderal caused heart valve problem in a patient.

  2. As a nurse practitioner I have to “appease” managers to pass my annual performance reviews, and often managers consider guidelines “best practice”. As well, I have to survive a provincial regulatory body review of some of my charts every 5 years, and audits are often completed by practitioners who consider guidelines as best practice. This sometimes leaves me feeling like I am walking through a minefield, trying to balance what I may recognize as an outdated or perhaps not most evidence based guideline with the external expectations placed on me.

  3. My practitioning body is trying to keep guidelines more uptodate and to flag guidelines that are out of date and may need review. I try and read the evidence that is new wait for it to be replicated in other trials and than weigh the impact on patient care with risk before deciding when to adopt. I am Obs/Gyne so at least in obstetrics there are very little new drugs which makes it easier and not a tonne of new gyne drugs. I do think it best to try and practice with evidence based guidelines and especially at least consider adopting recommendations in new guidelines but I do very much try and monitor cost and risk to patients.

  4. Great article! Indeed, I think most of us also keep an eye on This Changed My Practice as a source of patient-centred recommendations that are evidence-based or at least honest about the limitations of the evidence applicable to the issue in question.

  5. Many of us will feel like Laura Koop because assessments and audits are often based on such guidelines. Let us hope that as more information comes forth about harms from such unthinking regimented management those approaches will be abandoned.

    I personally have experienced the frustration and annoyance at being followed according to a guideline rather than heard as an individual regarding what issues and approaches I feel are right for me.

  6. Thanks a lot for the post.Really thank you! Much obliged.

  7. Well thought out, practical approach to the application of the veritable snowstorm of guideline- this balances recommendations with individual issues and patient preference.
    Thank you.

  8. Guidelines are just that – a guide. They should not be considered the only way to apply medical care, for the reasons that Dr. Etches makes so plain.
    I view guidelines as a good “prompt” for consideration of care, but not a rigid system that has to be followed slavishly.
    Thank you for reminding me why I try to do things the way you do!

  9. Thank you Dr. Etches for this insightful article and practical approach to incorporating EBM into clinical practice. I would also like to introduce everyone to non-industry funded EBM drug information services across Canada – academic detailing. In BC, PAD Service http://www.bcpad.ca, and more widely known RX Files (Saskatoon).

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