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Guidelines are written backwards

From Dr Adrian Midgley

Exeter

I read with interest the warning of the risk of legal consequences for GPs who don't follow guidelines – in this case the NICE guideline on suspected gynaecological cancer referral (News, 15 June).

Not for the first time, it occurred to me the problem with guidelines is that they generally relate to, proceed from, and assume the diagnosis – whereas patients have symptoms (and occasionally signs if you are lucky). In short, they are written backwards.

So what should be (at least) a three-dimensional matrix of atoms of information – symptoms, weightings, and actions – is presented as a horde of disconnected large monographs.

It is even more stupid when one considers the nature of forms (whether paper or the screen-forms that are found in GP computer systems and perhaps in hospital systems) and of clincial coding in general practice.

It is not easy for doctors to work from the indigestible to the unlikely.

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