guidelines

Elias Peter pheski69 at GMAIL.COM
Mon Dec 12 17:00:25 UTC 2016


This is a daily (hourly?) dilemma in primary care.

My personal approach was to have a conversation with the patient about the fact that some people with a great deal of experience but also conflicts of interest had looked at the evidence and published their opinion as to the implications of the evidence, but that it was pretty fuzzy. Then I would explain the options and try to differentiate with the patient which recommendations were unanimous, which were conflicted, which were based on good/bad/no evidence.

All this, of course, in addition to explaining the complex physiology, pathology, pharmacology, statistics involved. And eliciting the preferences and values of the patient.  And checking the various boxes and accomplishing the various unrelated tasks required by my employer, required of them by regulatory agencies and payors. And saving some time for documenting so that the institution can bill and collect for the work I have done.  And asking the patient if there is anything else they would like to address.

In a 20 or 30 minute appointment, because I long ago gave up on the 15 minute paradigm.

Peter Elias, MD

> On 2016.12.12, at 8:30 AM, Tom Benzoni <benzonit at GMAIL.COM> wrote:
> 
> 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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