Author: CauseHealth

Fiona Moffatt, Thinking about guidelines:

My research interest lies predominantly in the notion of knowledge translation, exploring the complex, non-linear relationship between what is ‘known’ and what is subsequently ‘done’. I understand evidence based guidelines and evidence based policy as key rhetorical devices (or technologies) bridging the liminal space between empirical knowledge and clinical practice. My methodological perspective is however, strongly influenced by the sociological discipline of STS, whereby all technologies are contingent, i.e. rejecting technological determinism. Continue reading “Guidelines in situ”

Roger Kerry, Thinking about guidelines:

My take home thoughts:

What is the real world, clinical role of guidelines? (provoked by Jeremy Howick’s suggestion that guidelines shouldn’t make recommendations, Sarah Weiten’s talk on values and mechanisms, and Sieste Wieringa’s talk on induction and reasoning)

Can a more holistic conceptualisation of causation really be integrated into guidelines which take population data as central to their development? (provoked by Stephen Mumford and Rani Anjum’s comments of the background philosophy of causation, as well as Karin Engebretsen and Elena Rocca’s talks on diagnosis and bench study data)

Can a guideline and evidence-based system truly move beyond hierarchies? (provoked by NICE’s Beth Shaw review of multiple evidence sources and their integration into guideline development. A beautiful talk, but I still think there is hierarchy at the core when push comes to shove. Show me I’m wrong!)

What is the future of implementation, governance, abuse-control strategies for guidelines? (provoked by Fiona Moffatt’s, Mary Chambers’, and Samantha Copeland’s highly informed musings on things from deep sociological concerns to PPI and the reality of the clinical shop-floor, and analogical thinking)

The planned conference for next year should turn out to be a hot-bed of challenge, controversy, and progress for all.

Stephen Mumford, Thinking about guidelines:

I was particularly interested in different models of decision making and the implicit assumptions we make about how this should work. In particular, the notion of a guideline seems up for grabs and I think it important that we do not inadvertently slip into one way of operating guidelines without philosophically scrutinising the idea. It would be easy, for instance, to interpret a guideline as a general rule, along the lines of ‘thou shalt not kill’. This sort of rule is interpreted as strict and exceptionless. The workshop confirmed that, irrespective of any intentions of those who write guidelines, there are pressures to follow them exactly. Failure to do so is often taken as a failure that leaves a clinician liable for any subsequent unfavourable outcome. Continue reading “The Notion of Guideline”

Rani Lill Anjum, Thinking about guidelines:

I was really interested in the questions of how guidelines could include more leeway for the health professional. Rigid guidelines offering cost efficient solutions (e.g. 15 minutes per patient, or 30) emphasises the rule utilitarian approach and makes it difficult to use judgement and experience to give the best health service for the individual patient. If the patient represents at least as much of the causally relevant evidence (medical history, genetics, life situation, etc.) as population data, then how come the latter is given epistemic priority?

I thought that there were many good intentions behind the guidelines, but also a wide range of interests depending on who commissioned the guideline and what they want to use it for. This is why I thought the tension between real and ideal is important. New public management emphasises top down management, controlling, reporting, standardisation and efficiency. In the clinical setting, this approach might create chronic illness, if we simply treat or test the symptoms that the patient reports. Those who work on the importance of patient context and stories (Trish, Matt, Brian, Anna-Luise) have important knowledge to share, and show also that the most efficient treatment of such illness is to take more time with the patient to figure out what is actually wrong before offering an intervention or a test. Why could this not be in guidelines about chronic illness, MUS and comorbidity? Then we would also avoid reductionism and dualism of treatment.