Tuesday, February 8, 2011

Rich On Clinical Guidelines

Physician-blogger "Dr. Rich" makes some rather pointed observations in his post, "Who Writes Those Clinical Guidelines, Anyway?"

Some excerpts:
...[T]he act of creating clinical guidelines is not inherently evil, and indeed, back in the day when guidelines were merely guidelines (instead of edicts or directives that must be obeyed to the last letter), creating clinical guidelines was a rather noble thing to do.

But today, we have physicians clamoring to become GOD panelists (Government Operatives Deliberating). These aristocrats of medicine will render the rules by which their more inferior fellow physicians, the ones who have actual contact with patients, will live or die.
Although (by his own admission) he engages in some pretty broad generalizations about physician personality types, he does put his finger on a central premise driving many of these would-be guideline-writers -- namely, they know best.

In other words, they know how medicine should best be practiced -- and their judgment should overrule that of the actual physician taking care of the actual patient juggling many complex factors specific to the individual case. The current government-endorsed "clinical guidelines" approach is merely a variant of the "central planning" fallacy that failed so miserably in the socialist Eastern bloc economies.

Of course, not every doctor enamoured of central planning is necessarily clinically inept. But many of them place too much faith in the power of central government -- and have too little respect for the rationality and integrity of ordinary physicians "in the trenches".

(Read the full text of "Who Writes Those Clinical Guidelines, Anyway?")