Guidelines – for the obedience of fools and the guidance of wise men?

Abstract

Guidelines for medical management are now part of medical life. A fool - loosely defined as someone who does not know much about a particular area of medicine - will do well to follow guidelines when treating patients, but a wise man (again, loosely defined as someone who does know about the disease in question) might do better not to follow them slavishly. The problem is that the evidence on which guidelines are based is seldom very good. Clinical trials have a variety of problems which often make their relevance to ‘real world’ medicine dubious. The interpretation of trial results depends heavily on opinion, and a guideline that purports to be evidence based is actually often opinion based. A guideline will depend on the opinions of those who wrote it, and the wise man will use his judgement and give due weight to his own opinions and expertise.