Clinical guidelines have a more fundamental flaw than those discussed recently in CMAJ.1,2 This flaw was expressed by the pioneer Harvard endocrinologist Fuller Albright. In his introduction to a textbook of medicine popular many years ago, he wrote that medicine can be practised by the rules (read guidelines) and they may help 90% of the time but the other 10% the rules will do more harm than they do good in the 90%.
Guidelines are helpful to those who have knowledge but are dangerous in the hands of those who do not, a group to whom guidelines may give confidence to exceed their knowledge. A physician without knowledge but with guidelines is like a monkey in a tree with a machine gun.
Signature
Marc Baltzan
Nephrologist Saskatoon, Sask.
References
- 1.Graham ID, Beardall S, Carter AO, Glennie J, Hébert PC, Tetroe JM, et al. What is the quality of drug therapy clinical practice guidelines in Canada? CMAJ 2001;165(2):157-63. [PMC free article] [PubMed]
- 2.Lewis SJ. Further disquiet on the guidelines front [editorial]. CMAJ 2001;165(2):180-1. [PMC free article] [PubMed]