Hospitals

Clinical guidelines growing in number, just like federal tax rules

The above graph from the Cato Institute demonstrates the growing complexity of the U.S. tax code over the years. After doing my taxes recently and trying to track the ins and outs of the law for my wife’s private practice, I can attest to the graph’s accuracy. But then I was reading an interesting editorial […]

By Westby G. Fisher, MD on April 21, 2011 11:21 am

The above graph from the Cato Institute demonstrates the growing complexity of the U.S. tax code over the years. After doing my taxes recently and trying to track the ins and outs of the law for my wife’s private practice, I can attest to the graph’s accuracy.

But then I was reading an interesting editorial in Circulation: Arrhythmia and Electrophysiology by N.A. Mark Estes III, MD and Jonathan Weinstock, MD that reviewed an article by Roos, et al in the same journal that found only 27 of 698 guideline recommendations from the European Society of Cardiology (median 1.2% per guideline [IQR 0.95% to 3.7%]) were correctly referenced as Class I or III Level of Evidence A recommendations, calling into question the accuracy of guideline recommendations. In their editorial, Estes and Weinstock defended the guideline process but also mentioned the following shocking statistic:

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There have been 2413 guidelines published by 267 organizations over the last 2 decades.

To bolster their point, they referenced the government’s own website designed to track these guidelines.

So I checked the number of guidelines so far just for cardiovascular diseases: 457 and counting.

Given this, one thing is becoming abundantly clear:

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… doctors will soon be behaving less like doctors and more like tax accountants.

References:
Estes NA M, Weinstock J. Guidelines for Cardiac Arrhythmias
Practice Makes Progress Circulation: Arrhythmia and Electrophysiology. 2011; 4: 119-122.

Roos M, Brodbeck J, Sarkozy A, Chierchia GB, De Asmundis C, Brugada P. Critical Analysis of the Scientific Evidence Behind International Guidelines Related to Cardiac Arrhythmias Circulation: Arrhythmia and Electrophysiology. 2011; 4: 202-210.

The author, Dr. Westby G. Fisher, is a cardiologist at NorthShore University HealthSystem who writes regularly at Dr. Wes.

Westby G. Fisher, MD
Website

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.

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