Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A solution for clinical guideline overload

Ira Nash, MD
Conditions
November 5, 2013
Share
Tweet
Share

I think I am like many practicing physicians in my love-hate relationship with clinical practice guidelines.

On the one hand, it is often helpful to look up a set of evidence-based recommendations on a particular clinical issue, and I feel particularly fortunate that the American College of Cardiology and the American Heart Association have collaborated to produce high quality guidelines on a wide-range of subjects relevant to my practice.

On the other hand, I am well aware of the shortcomings of practice guidelines, including the limitations of the underlying evidence base, the challenge of synthesizing the available evidence into guidelines, and the often limited applicability of recommendations to clinical practice.

Even these well-known problems with practice guidelines don’t capture the broader issue of guideline overload. There are now so many guidelines, that the old problem of “keeping up with the literature” has been matched by the contemporary problem of “keeping up with the guidelines” and some areas of clinical practice have many competing guidelines with inconsistent recommendations.

I searched for “hypertension” on the National Guidelines Clearinghouse site and got a list of 548 relevant guidelines, all of which had met the strict criteria for inclusion on the site. Thanks a lot.

A related aspect of guideline overload is the challenge of caring for patients with multiple conditions, each of which may be the subject of recognized guidelines. A paper in the Annals of Internal Medicine presented an interesting response, at least with regard to guidelines for preventive care.

Researchers built a mathematical model to help clinicians prioritize preventive interventions (e.g. quitting smoking vs. losing weight) for patients with multiple co-morbid conditions. They limited the inputs to the US Preventive Services Task Force recommendations, and were clear that their effort was intended only as a proof of concept, but it seemed to me that the approach has real merit.

They used two different imaginary patients, and were able to show that their profiles of the most effective preventive measures were different. They conclude: “models of personalized preventive care may help clinicians prioritize … recommendations at the patient level. Future work may help determine whether model-based personalization is feasible at the point of care and is associated with improved health outcomes.”

In other words, if this kind of information can be presented to clinicians as they care for patients (say, by embedding it in an EMR), and if it can be shown to make a real positive difference in how patients do over time (the real test of utility of everything we do), then this is a real advance.

Ira Nash is a cardiologist who blogs at Auscultation.

Prev

Obamacare's effect on small business: An unintended consequence?

November 4, 2013 Kevin 17
…
Next

Why psychiatry is handicapped today

November 5, 2013 Kevin 2
…

Tagged as: Primary Care

Post navigation

< Previous Post
Obamacare's effect on small business: An unintended consequence?
Next Post >
Why psychiatry is handicapped today

ADVERTISEMENT

More by Ira Nash, MD

  • Let’s stop trying to change what doctors do

    Ira Nash, MD
  • Keeping up with the rapid developments in mobile health technology

    Ira Nash, MD
  • Not all doctors are physicians

    Ira Nash, MD

More in Conditions

  • Coconut oil’s role in Alzheimer’s and depression

    Marc Arginteanu, MD
  • Ancient health secrets for modern life

    Larry Kaskel, MD
  • How the internet broke the doctor-parent trust

    Wendy L. Hunter, MD
  • Mpox isn’t over: A silent epidemic is growing

    Melvin Sanicas, MD
  • How your family system secretly shapes your health

    Su Yeong Kim, PhD
  • The human case for preserving the nipple after mastectomy

    Thomas Amburn, MD
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy
    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • How tragedy shaped a medical career

      Ronald L. Lindsay, MD | Physician
    • A doctor’s guide to preparing for your death

      Joseph Pepe, MD | Physician
    • Coconut oil’s role in Alzheimer’s and depression

      Marc Arginteanu, MD | Conditions
    • How policy and stigma block addiction treatment

      Mariana Ndrio, MD | Physician
    • Unused IV catheters cost U.S. hospitals billions

      Piyush Pillarisetti | Policy
    • Why U.S. universities should adopt a standard pre-med major [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A solution for clinical guideline overload
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...