Health Care Guidelines:Should Physicians Be Required To Follow Them?
I just want to call your attention to a very important article in yesterday’s New York Times (18 August 2009, page B1). The article was entitled “Diabetes case shows pitfalls of treatment rules,” and was written by Barry Meier. The article discussed the controversy surrounding a national guideline for treating patients with diabetes that was written in 2006 and withdrawn last year. Basically, the national guideline recommended aggressive treatment of high blood glucose levels in all patients with diabetes only to reverse its recommendations; new data showed that for some patients, following the guidelines would increase morbidity and mortality. The specific details of the case are important but perhaps not so important as the information it provides regarding how medical treatment guidelines are established and their pitfalls.
So-called national guidelines, consensus statements, and expert opinions should all be viewed with considerable suspicion since they are often put together by many interested parties with very different points of view. Typically, such treatment guidelines are compromises hammered out among physician experts, insurers, special interest groups and are anything but “consensus statements.” The problem with consensus statements and treatment guidelines put together by expert groups is that however incorrect they might be, individual physicians who ignore these guidelines when treating their patients run the risk of not having the treatments covered by health insurance or by risks of malpractice lawsuits when results are not satisfactory. Anyway, I highly recommend that you read the article and I can asure you that my recommendation was not put together by a committee.
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