Practice Guidelines and Practicing Medicine

Are They Compatible?

Published in: Journal of the American Medical Association, v. 262, No. 21, 1989, p. 3027-3030

Posted on RAND.org on January 01, 1989

by Robert H. Brook

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In this time of ever-increasing financial pressure on medical facilities and physicians, the economic value and appropriateness of nearly every aspect of clinical practice is under scrutiny. Physicians make many daily decisions regarding patient treatment that are derived from knowledge of the patient and the probable value of a test or treatment. But does the average physician really understand the cost-benefit advantage of one test or procedure over another for a particular patient? What is the trade-off between the experience of one physician who selects a treatment for a unique patient and a medical guideline for the treatment of a similar, but idealized patient culled from the experience of a group of physicians? Experience seems to be pushing medicine into the direction of medical guidelines as the standard of treatment decisions. Such guidelines would be oriented towards medical outcomes and, once adopted, the methods outlined would become the norm against which practice would be assessed. While improving outcome, rigid adherence to medical guidelines can lead to excessive costs. The development of medical standards must also be tied to elaborate data collection and analysis procedures that will insure that their value is maintained and kept current with new research and the introduction of new procedures. The collection of such data could lead to: a means for self-evaluation by individual physicians, providing consumer/patient information, revitalizing medical textbooks and increasing the importance of information science in medical school. This trend could allow licensing boards to evaluate performance when recertifying physicians. In addition, insurance companies could base their decisions of preferred provider designations on how well individuals or institutions meet acceptable standards. A patient and physician could be more effective in assessing the patient's medical condition together. The legal system could use the standards to develop more appropriate definitions of malpractice and, as a result, malpractice claims and costs could be reduced.

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