Volume 15, Number 2, June 2003

Evidence-based Medicine and Practice Guidelines: Solution or Problem? Part 2. Practice Guidelines

Angelo Antonio Bignamini

Centre for Bioethics, School of Medicine, Sacred Heart Catholic University, Rome, Italy

Abstract
Practice guidelines are used to indicate to physicians what to do in clinical situations. Guidelines effectively synthesise, in simple statements, work-flows, and algorithms, the available clinical information and can direct physicians to use proven procedures and not to use objectively ineffective procedures. However, non-critical use of guidelines can lead to serious risks. Practice guidelines are structurally limited in coverage, since only few populations and few procedures can become the object of evidence. The applicability of guidelines to individual patients is limited since the statistical inference on which they are based is applicable to populations, not to individuals. This can also instigate legal and ethical problems. Finally, the generation of guidelines can be biased. Practice guidelines can be useful for the education of health care workers and may be an effective support tool for planning the requisition of medical resources. However, guidelines must not restrict the right of each patient to the best available treatment, nor the right and duty of each physician to apply to each patient the therapeutic approach considered most suitable for a patient in specific circumstances. Further, the physician's compliance with the recommendations of practice guidelines is often a shield against macroscopic practice mistakes, rather than a way to achieve the best therapeutic interest for individual patients in an ethically appropriate way.

Key words:
Practice guidelines, Methods

Asian J Oral Maxillofac Surg. 2003;15:80-89.

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