Monday, August 20, 2007

Guidelines: Not for Doctors Anymore

My printer nearly burned up printing the nearly 160-page guidelines of the American College of Cardiology for management of unstable angina and non-Q wave myocardial infarctions (heart attacks).

While these "guidelines" are helpful and contain the latest in evidence-based research to justify the recommendations, they now exceed the length of chapters of our classic textbooks of medicine for their specific problem. It was interesting to note that these guidelines dwarf the classic chapter in Braunwald's Heart Disease (7th ed.) with its chapter on the same information that spans just 30 pages.

These guidelines are now being written more for regulators, I'm afraid, than doctors.


References: Cannon CP and Braunwald E. "Chapter 49, Unstable Angina and Non-ST Elevation Myocardial Infarction" in Zipes DP, Libby P, Bonow RO, Bruanwald E (eds.), Braunwald's Heart Disease - A Textbook of Cardiovascular Medicine, 7th ed., pp 1243-1273.


Anonymous said...


who can read them anymore?
unstable angina, stemi, lipids, htn, a fib, a fib ablation, svt, vt, echo, cardiac ct, cv disease in women, calcium scoring, carotid stenting, peripheral vasc disease, etc etc. how many pages does that add up to?

are we 'allowed' to use amiodarone for atrial fibrillation anymore? it's in the guidelines so it must be okay right?

Richard A Schoor MD FACS said...

Unfortunately, people often do not know the difference between guidelines and law. Guidelines are suggestions, and the good doctors know them, and then veer from them in treating the patient correctly, as an individual. There is no question that guidelines in medicine have become fodder for insurance co's, regulators, and attorneys (plaintiff and defense).
It is my hope that blogger such as yourself can help in stemming this rediculous tide.