Published by the American College of Physicians Observer, May 1997, vol. 17, no. 5, p. 13.


Following Guidelines May Not Be The Answer:
Dr. Brent James explains that by deviating fron clinical guidelines, physicians can actually help improve patient outcomes.

"If you're not deviating from a (practice) guideline, something is wrong with you," Brent C. James, MD told physicians at the C. Wesley Eisele Lecture on physician leadership in building health systems.

Dr. James, executive director of the Institute for Health Care Delivery Research at Intermountain Health Care in Salt Lake City, explained that many guidelines aren't backed by scientific data and may not represent the best care. At best, he said, guidelines are 20% scientific evidence and 80% consensus.

As a result, Dr. James said he would question a physician who completely followed all clinical guidelines. In fact, he encouraged physicians to view deviating from guidelines as an opportunity to learn about differences in clinical thought and to work toward improving patient outcomes. "(Deviations don't mean there is) something wrong. It means we need to change protocol."

Deviating from guidelines also gives physicians the chance to redefine managed care. "It's our choice," Dr. James said. "In the face of managed care, can we return to the roots of good patient care?...We must come together as peers and regain the moral foundation to allow us to control the debate."


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