Guidelines — not always an easy answer
CMAJ 1999;160:983
See response from: F. Tudiver, et al
The Oct. 6, 1998, edition of CMAJ included 3 seemingly unrelated articles, which, on reflection, I believe are very much connected. The article that started it all was the editorial on the use (or non-use) of clinical practice guidelines by family physicians [full text].1
The modern approach to solving problems in teaching is to ask those receiving the message what is wrong with the message or the communicator. The article by Claude Beaudoin and colleagues [full text]2 illustrates this point: investigators studying the acquisition of humanistic skills and attitudes by trainees asked the students to judge their mentors on these attributes. Yet this approach is not being applied to clinical practice guidelines. Although investigators recognize that such guidelines are not unanimously accepted by medical practitioners, they always seem to ask "What is wrong with the docs?" or "How can they be 're-educated'?" We need more research into how the guidelines themselves might be deficient.
The answer might lie in the editorial by John Hoey about science's attitude toward alternative medicine [full text].3 As he states in the first sentence, "When passion edges into zeal and frustration becomes arrogance, scientists lose credibility and risk depriving us of their considerable and unique understanding of the intricacies of biology." And, I might add, they risk not asking the right questions in their pursuit of the truth.
Tom Vandor, MD
Ormstown Medical Center
Ormstown, Que.
tvandor@rocler.qc.ca
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References
- Tudiver F, Herbert C, Goel V, for the Family Physician Study Group, Sociobehavioral Cancer Research Network, National Cancer Institute of Canada. Why don't family physicians follow clinical practice guidelines for cancer screening? CMAJ 1998;159(7):797-8.
- Beaudoin C, Maheux B, Côté L, Des Marchais JE, Jean P, Berkson L. Clinical teachers as humanistic caregivers and educators: perceptions of senior clerks and second-year residents. CMAJ 1998;159(7):765-9.
- Hoey J. The arrogance of science and the pitfalls of hope. CMAJ 1998;159(7):803-4.
