Crossing the guideline

Guidelines, guidelines. My desktop, bookshelves and floor are covered with them. Advising on everything from diabetes to incontinence, they come from multiple agencies in increasing sizes and scope.

Some guidelines are excellent; they save doctors from a long trawl through the evidence and give directions in shorthand that everyone can understand. But Baroness Young, chair of England’s new health regulator, the Care Quality Commission, seems to have an unnerving faith in guidelines. Under her aegis, the CQC seems to have general practices in its firing line, and sees adherence to guidelines as a proxy for GP quality. This is alarming.

There are several issues the baroness might not be aware of – she does not have a healthcare background, after all. First, guidelines are a guide, not a formula. If guidelines for a generic population could be applied to everyone, why bother with anything but a computer and automated prescriptions? Individuals have different preferences, concerns, histories and views. The day I start ignoring the variability of people to enforce homogenous guidelines will be, I hope, the day that I lay my stethoscope down and do something else instead.

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Update: 27th April

I am feeling a bit reassured. Here is an excerpt from Baroness Young’s emailed letter of today:

“I, and the Care Quality Commission agree with NICE and don’t advocate slavish obedience to guidelines but want to assess whether clinicians have considered good, evidence based guidance when making appropriate decisions in the circumstances of the individual, in consultation with patient and/or carer.”

I think I can live with that. Baroness Young  also points out that she has worked in health services management for more than 20 years: but then again, clinical work and decision making is something rather different.

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