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Psychiatric Times. Vol. 23 No. 14
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Concerns About Practice Guidelines

By Michael A. Fauman, MD, PhD | December 1, 2006

All clinicians are subject to some regulation by their specialty and by society to ensure that the patients they treat are receiving appropriate care. That is simply a fact of professional life that is unlikely to change. The question is, what is the balance between freedom of action and regulation? The best solution is the one that ensures the most appropriate care for patients while interfering the least in the physician-patient relationship.

Since physicians look to their colleagues the most for consultation and guidance, perhaps this process can be formalized as a method of correcting potential biases and misinformation.12 An effective system might provide some type of real-time online peer review and consultation system that physicians could use both to ask their colleagues for clinical advice and to observe how their colleagues have managed comparable clinical problems. The goal, as always, would be to improve the quality of care.

Dr Fauman is the author of Negotiating Managed Care: A Manual for Clinicians and Study Guide to DSM-IV-TR, both published by American Psychiatric Publishing, Inc. He is adjunct clinical associate professor of psychiatry at the University of Michigan and medical director of Magellan Health Services of Michigan.

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References
1. Kane JM, Leucht S, Carpenter D, Docherty JP. Expert consensus guideline series. Optimizing pharmacologic treatment of psychotic disorders. Introduction: methods, commentary, and summary. J Clin Psychiatry. 2003;64 (suppl 12):5-19.
2. Hampton JR. Guidelines—for the obedience of fools and the guidance of wise men? Clin Med. 2003;3: 279-284.
3. Tversky A, Kahneman D. Judgment under uncertainty: heuristics and biases. Science. 1974;185:1124-1131.
4. Kahneman D, Slovic P, Tversky A, eds. Judgment Under Uncertainty: Heuristics and Biases. Cambridge, United Kingdom: Cambridge University Press; 1982.
5. Rush AJ, Fava M, Wisniewski SR, et al. Sequenced treatment alternatives to relieve depression (STAR*D): rationale and design. Control Clin Trials. 2004;25:119-142.
6. Rush AJ, Trivedi MH, Wisniewski SR, et al. Bupropion-SR, sertraline, or venlafaxine-XR after failure of SSRIs for depression. N Engl J Med. 2006;354:1231-1242.
7. Sachs GS, Thase ME, Otto MW, et al. Rationale, design, and methods of the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biol Psychiatry. 2003;53:1028-1042.
8. Hayward RS, Guyatt GH, Moore KA, et al. Canadian physicians' attitudes about and preferences regard- ing clinical practice guidelines. CMAJ. 1997;156:1715-1723.
9. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458-1465.
10. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press; 2000.
11. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001.
12. Cranney M, Warren E, Barton S, et al. Why do GPs not implement evidence-based guidelines? A descriptive study. Fam Pract. 2001;18:359-363.


 
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