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Clinical Chemistry 48: 9-10, 2002;
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(Clinical Chemistry. 2002;48:9-10.)
© 2002 American Association for Clinical Chemistry, Inc.

Editorial

Practice Guidelines and Practicing Physicians—Who’s Guiding Whom?

Carl van Walraven1

1 Department of Medicine at the University of Ottawa, Clinical Epidemiology Unit, Ottawa Health Research Institute, Institute for Clinical Evaluative Sciences, Ottawa, Ontario, K1N 5K3 Canada

aAddress for correspondence: Department of Medicine, the Ottawa Hospital–Civic Campus, F-660, 1053 Carling Ave., Ottawa, ON, K1N 5K3 Canada. Fax 613-761-5351; e-mail carlv@ohri.ca.

When I was a medical student, I had a medicine rotation with a spectacular senior resident and a less than stellar staffperson. The resident was very smart, terrifically organized, and ran the service extremely efficiently. The staffperson had probably spent too much time away from clinical medicine. I distinctly remember team rounds in which our resident would present cases such that the staffperson appeared to make the big decisions ("I was uncertain what to do but thought that you would likely get a bone marrow biopsy", to which the staffperson would usually nod and muse, "Good plan"). As a student, I was struck by the irony of a resident guiding the staffperson. Now that I am a staffperson, who probably spends too much time away from clinical medicine, I am struck by how cunning the staffperson was to listen carefully to the resident and accept the valid decisions.

Like a wise staffperson, guidelines are supposed to help physicians practice best medicine within an environment containing an ever-increasing volume of information. Although guidelines have been successful in changing physician practice (1)(2. . . [Full Text of this Article]


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