guidelines

Tom Benzoni benzonit at GMAIL.COM
Mon Dec 12 16:04:03 UTC 2016


Dr. Berlin:

Then you get the irony.
We expect the bedside practitioner, beset by time and performance
pressures, to make decisions the experts can't/don't make.

for the curious:
Pubmed on study: https://www.ncbi.nlm.nih.gov/pubmed/27905006

Study abstract: http://link.springer.com/article/10.1007%2Fs11739-016-1580-x

The guidelines studied are in References section of the online version of
this study.

Evidentiary tables are linked in the abstract supplement.

tom


On Mon, Dec 12, 2016 at 9:47 AM, Leonard Berlin <lberlin at live.com> wrote:

> I'm a radiologist and not an ED doc, but I think my answer is short,
> simple, and applies to all physicians under the circumstances you
> describe, namely:
>
>
>     Read all three  guidelines carefully, and then use your own judgment
> to determine   *what you believe*  to be the standard of care,  and
> then treat the patient accordingly.
>
>
> Lenny Berlin
>
>
> ------------------------------
> *From:* Tom Benzoni <benzonit at GMAIL.COM>
> *Sent:* Monday, December 12, 2016 7:30 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> *Subject:* [IMPROVEDX] guidelines
>
> Group challenge:
> 3 societies publish guidelines on ER treatment of A fib.
> ESC, ACC, Canada
> -Give strong recommendations based on weak evidence (their own finding) of
> expert opinion, not clinical trials
> -Among 21 questions addressed, 5 completely different recommendations, 6
> partial agreements, 10 agreements
> -Only 1 group recommended absence of conflict of interest for >50% of its
> panel.
>
> Thus:
>
> Do you:
> -Take the result with which you disagree, find a guideline that agrees
> with you and pronounce the care bad
> or
> -Do the opposite
> or
> Poclaim guidelines are useless and take pity on the person having to
> select these at the point of care?
>
> tom
>
> ------------------------------
>
>
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>
>
> Moderator:David Meyers, Board Member, Society for Improving Diagnosis in
> Medicine
>
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>
>






Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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