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Tuesday, June 10, 2008

Guidelines-good suggestions or edicts or (sometimes) shameless self promotion

Two medical bloggers have recently made very cogent comments regarding medical guidelines,
Dr. Robert Centor and DrRich. Medical students and house officers would do well to read both because they have never lived in a medical world without the guidelines and physicians reading the blogs may get a different perspective on what is being done to them in the name of doing something for them and patients and to further the abstract goal of quality. (the 2 postings are highlighted below)

Both make the very important observation that guidelines that purport to be evidence based may be just as likely as the advice from your uncle Cyrus or your charming used car salesman to reflect their own personal and professional interests and are in word-biased. No, they all are not- at least not to the same degree- if there were things were that simple, you could just ignore all of them.

And of course, we should not forget Goodhart's Law, namely when a measure becomes a target it no longer functions as a measure.

Dr. Centor has informed us previously us about the nature of pharyngitis in adults, a subject he has studied and written about for a long time and in this recent entry delves into PSA screening. The bottom line is that there are numerous guidelines and they all don't agree with each other. Various guidelines writing groups begin their task with different world views.

The public health oriented wonks have a different perspective about PSA (or whatever screening procedure is at issue) screening that a practicing urologist might.The former group has to consider the total cost to society( which I believe is basically a bogus concept in that context) while the later wants to detect cancer earlier and yes, he has the economically advantageous opportunity to do more procedures ( from biopsy to surgery) if lots of men have their PSA values measured. If you believe that entities allegedly writing in the context of the greater good, really only have their nebulous goal in mind (this includes the prestigious USPSTF panels), you should read this entry.

DrRich takes us through the fascinating history of the rise and fall and rise of the concept of "metabolic syndrome" and what, if any, specialty medical group should promote and exploit it and coins (I think he coined it) the intriguing and thought provoking term of predatory guidelines.


Anonymous said...

Can you give us the links to their posts?

Thanks, Marilyn Mann

james gaulte said...

Click on "delves" for Dr.Centor's comments and click on "predatory guidelines" for DrRich's thoughts.I don't know why I made the links so tangential.