Guidelines issued by learned societies and groups of experts are extremely valuable to family physicians. They enable us to deal with a subject quickly and to make clear and precise recommendations. They allow us to avoid searching through the literature for scientific proof. In many ways, they have replaced manuals by being much more rigorous and trustworthy. They have created a sense of solidarity and cohesiveness among practitioners. We generally give them a lot of credibility.
Perhaps too much!
In fact, the downside to guidelines is that ignoring them leaves us open to problems. Woe betide the unfortunate physician who has not followed the guidelines to the letter when something bad happens. Such physicians are at serious risk of being blamed and of having to justify their conduct. They will have to explain exactly why they did not follow the guidelines.
Despite their immense popularity, there is nothing to indicate that guidelines have a monopoly on truth or that they even help improve the health of the population. This is the subject of 3 articles published this month in Canadian Family Physician. McIvor and colleagues ( page 673) observe that, despite widespread dissemination of the Canadian Consensus Guidelines on Asthma in 2001, the well-being of asthma patients, as measured by their control of the disease, has not improved at all. Worrall et al ( page 667) demonstrate that the best way to decide whether to prescribe antibiotics for a sore throat is to use a rapid diagnostic test rather than follow the guidelines. As for McCormack ( page 614), he surges into the debate against using β-blockers to treat hypertension even if they are recommended by the Canadian Hypertension Society.
Despite their usefulness and popularity, guidelines are not infallible and they are not a panacea. Moreover, there are all sorts of guidelines—good ones and not so good ones. If some are rigorous, the result of exhaustive analysis of the literature and exempt from outside influence, others seem biased, infiltrated by interest groups, and funded by industry. The first kind usually come from well-known organizations and are published in serious journals that are peer-reviewed, while the other kind are often the work of a handful of pseudo-champions under the influence of powerful sponsors.
So, the recommendations found in guidelines should remain just what they are: advice, not orders.
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