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Medical guidelines: pros and cons

Medical guidelines are a good thing if doctors are failing to provide optimum patient care. But they should not be allowed to hinder doctors seeking to identify the best care for each individual patient.

In France, doctors are free to prescribe as they see fit, in the patient’s best interest. And yet various bodies such as the French National Authority for Health (HAS) and the national health insurance system (Sécurité Sociale) are seeking to influence doctors’ prescriptions, to promote best medical practice and cut healthcare costs.

On the plus side, the patient-consumer can hope that a degree of health "standardisation" will help rid the healthcare system of obsolete or non-established practices. Health professionals themselves can find it reassuring to practice healthcare that is more normative and collective, and less artisanal or idiosyncratic.

The legal scope of the various current medical guidelines is variable, and, overall, not particularly binding. It is important to stress that medicine cannot be completely standardised, because all patients are different. Doctors would not be acting responsibly if they meekly applied official guidelines in all cases.

Doctors must be able to justify their choices (to their patients, their own conscience or a judge), on the basis of robust evidence, whether there are official guidelines or not, and even using reliable evidence that contradicts the official recommendations.

©Prescrire April 2008

Source: "Force normative des recommandations : un concept à géométrie variable" Rev Prescrire 2008; 28 (294) 295-299.

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