Friday, May 6, 2011

Perednia On Clinical Guidelines

The concept of clinical practice guidelines is one of the key cornerstones of ObamaCare. The theory is that there is "too much variation" in how individual doctors practice around the country. Hence, in the name of preserving quality and "cost effectiveness", physicians will be increasingly pressured by the government to follow clinical practice guidelines.

Dr. Doug Perednia addresses this issue in his essay, "Dangers of strict adherence to clinical guidelines", which draws extensively from an earlier essay by cardiologist Dr. Rich Fogoros, "The Abuse of Implantable Defibrillator Guidelines".

Dr. Perednia makes a couple of key take-home points:
1) Clinical guidelines often do not capture the reality of "in the trenches" medicine. Patients are all individuals, and frequently do not present as described in the textbooks. Hence, adherence to clinical guidelines will often mean that patients won't receive certain treatments that are actually medically appropriate for their particular individual circumstances, because they fall outside of the theoretical guidelines.

2) Many of the guidelines are based on very questionable evidence, even though bureaucrats will insist on calling them "evidence based" practices. And deviating from these guidelines will be falsely characterized as practicing "non evidence based" medicine, even when it is medically appropriate.
(Read the full text of "Dangers of strict adherence to clinical guidelines".)

Of course, clinical guidelines per se are not automatically wrong. When they are solidly grounded in medical science, they can be valuable practice aids -- when properly used by a physician who integrates them with the specific facts of the specific patient he or she is treating. But they should not be used as a substitute for the independent rational judgment of the practicing physician. That's why medicine is a combination of science and art -- not merely following "cookbook" protocols.

As Dr. Perednia emphasizes, "Strict adherence to standardized guidelines ought to raise a red flag." That's a sign that a doctor has abdicated his own judgment and his own mind to his bureaucratic masters -- at his patient's expense.

The fundamental problem with the current ObamaCare push towards "clinical guidelines" is that it's just another variation of the fallacious central-planner mindset that ruined the economies of the Eastern Bloc countries:

Just as those European central planners believed that bureaucrats could know better than you how to spend your own money, today's medical bureaucrats believe they know better than the actual treating physician as to what medical care you should (or should not) receive.

Only this time, you won't just be risking getting bad automobiles. Rather, you'll be risking your life.