© 2002 by Heart
EDITORIAL
Some reflections on how not to get bitten by a clinical guideline
Correspondence to:
Correspondence to:
David Hart, Barrister, 1 Crown Office Row, Temple, London EC4Y 7HH, UK;
david.hart@1cor.com
Clinical guidelines can operate legally as a sword, in that doctors can be criticised for not adhering to them, or as a shield to rebut criticism of inadequate treatment
Keywords: clinical guideline; National Institute for Clinical Evidence
The last few years have seen the rise of the clinical guideline, in particular those generated from central National Health Service (NHS) bodies such as the National Institute of Clinical Excellence (NICE). Some praise these nationwide emanations as promulgating the brave new world of robust evidence based medicine, others characterise (or caricature) them as dirigiste measures leading to "cookbook medicine" underscored by insidious rationing of the ingredients. This article, by a lawyer, does not seek to contribute to that debate. Its subject is very different. What legal effect do these guidelines have, as between doctor, patient and disciplinary body? More particularly, what is a clinician to do if he or she is seriously troubled about some specific recommendation in a guideline?
Clinical guidelines can operate legally in two principal ways, as a sword in that doctors can be criticised for not adhering to them, or as a shield in that
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