Medicine
A recent national survey of internal medicine and family physicians published in the Archives of Internal Medicine found that 42 percent of physicians felt that their patients were getting "too much" health care, while only 6 percent thought that patients were receiving "too little." These opinions contrast with multiple previous studies showing that primary care clinicians fall short when it comes to providing guideline-recommended care; a 2007 study, for example, found that children received less than half of indicated care.
The best guidelines share several characteristics: they begin with a comprehensive review of the literature; they carefully assess the quality of the literature to identify the best studies; they base their recommendations on the best studies; and they tell us the strength of the evidence that supports each key clinical recommendation. In other words, they are founded on the principles of evidence-based medicine, which strives to make decisions on the best available information—“best” implying that the evidence is graded, so that one has a sense of what is good evidence and what is not, and “available” implying that the literature search is comprehensive. Transparency is the key: readers should know why each recommendation is made and whether it represents opinion, theory, or fact. Finally, guidelines should be independent of industry support (an all-too-common occurrence) and should clearly identify any potential conflicts of interest of the authors. Ideally, guideline authors should have no conflicts of interest, which can diminish the quality and validity of the guideline.
- Financial Conflicts Of Interest Have No Place On Guideline Panels
In a series of editorials in the New England Journal of Medicine earlier this year, Dr. Lisa Rosenbaum stirred controversy by suggesting that policing of pharmaceutical conflicts of interest in medicine had gone too far. These editorials and...
- Decontaminating The Medical Literature
To ensure that its clinical review articles reflect current medical literature, the American Family Physician journal (of which I am an associate deputy editor) requires prospective authors to consult evidence-based resources that synthesize the...
- Why Conflicting Guidelines Can Be Good For Patients
Many of the best-read posts on Common Sense Family Doctor have voiced my strong opinions regarding guidelines. After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for...
- New Statin Guidelines And Other Notable Medical Reversals
The recently published American College of Cardiology / American Heart Association cholesterol treatment guideline, which updates the National Heart, Lung, and Blood Institute's Adult Treatment Panel III recommendations that have guided...
- Compromising The Medical Literature
To ensure that its clinical review articles reflect current medical literature, the American Family Physician journal (of which I am an editor) requires prospective authors to consult several evidence-based resources that synthesize the best available...
Medicine
Family physicians and the Goldilocks principle
A recent national survey of internal medicine and family physicians published in the Archives of Internal Medicine found that 42 percent of physicians felt that their patients were getting "too much" health care, while only 6 percent thought that patients were receiving "too little." These opinions contrast with multiple previous studies showing that primary care clinicians fall short when it comes to providing guideline-recommended care; a 2007 study, for example, found that children received less than half of indicated care.
So which is it: too much care, too little, or some of both? And how can AFP help family physicians avoid these extremes and strive for the happy medium, which in other fields is known as the "Goldilocks Principle"? In addition to bringing readers the latest Practice Guideline updates, such as the Centers for Disease Control and Prevention's 2011-12 recommendations for influenza vaccination, we provide information that allows you to evaluate these guidelines against the best design criteria previously proposed by AFP Deputy Editor Mark Ebell, MD, MS:
The best guidelines share several characteristics: they begin with a comprehensive review of the literature; they carefully assess the quality of the literature to identify the best studies; they base their recommendations on the best studies; and they tell us the strength of the evidence that supports each key clinical recommendation. In other words, they are founded on the principles of evidence-based medicine, which strives to make decisions on the best available information—“best” implying that the evidence is graded, so that one has a sense of what is good evidence and what is not, and “available” implying that the literature search is comprehensive. Transparency is the key: readers should know why each recommendation is made and whether it represents opinion, theory, or fact. Finally, guidelines should be independent of industry support (an all-too-common occurrence) and should clearly identify any potential conflicts of interest of the authors. Ideally, guideline authors should have no conflicts of interest, which can diminish the quality and validity of the guideline.
There are, of course, many reasons - financial, medical-legal, and practical, to name a few - that care may diverge from that supported by the best evidence-based guidelines. Still, we hope that every section of the journal makes it easier for family physicians to provide care that is "just right."
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The above post was first published on the AFP Community Blog.
- Financial Conflicts Of Interest Have No Place On Guideline Panels
In a series of editorials in the New England Journal of Medicine earlier this year, Dr. Lisa Rosenbaum stirred controversy by suggesting that policing of pharmaceutical conflicts of interest in medicine had gone too far. These editorials and...
- Decontaminating The Medical Literature
To ensure that its clinical review articles reflect current medical literature, the American Family Physician journal (of which I am an associate deputy editor) requires prospective authors to consult evidence-based resources that synthesize the...
- Why Conflicting Guidelines Can Be Good For Patients
Many of the best-read posts on Common Sense Family Doctor have voiced my strong opinions regarding guidelines. After I left my position as a staffer for the U.S. Preventive Services Task Force in November 2010, it was three years before I was tapped for...
- New Statin Guidelines And Other Notable Medical Reversals
The recently published American College of Cardiology / American Heart Association cholesterol treatment guideline, which updates the National Heart, Lung, and Blood Institute's Adult Treatment Panel III recommendations that have guided...
- Compromising The Medical Literature
To ensure that its clinical review articles reflect current medical literature, the American Family Physician journal (of which I am an editor) requires prospective authors to consult several evidence-based resources that synthesize the best available...