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Independents' Day

This guidance begins a change in the way we practice

Dr Julian Treadwell, vice chair of the RCGP’s standing group on overdiagnosis, welcomes the publication of NICE’s long-awaited multimorbidity guidelines.

NICE have done a commendable job addressing perhaps the most challenging aspect of medical practice today. They outline some practical and guiding principles to use when dealing with multimorbidity, though inevitably these raise challenges regarding their implementation – time constraints and communication issues in particular.

Importantly, this guideline is explicit in stating that the application of single condition guidelines without consideration of the wider picture is not appropriate medicine - something every GP knows, as do NICE, though this may not have been the message received over the years.

The inclusion of a database of treatment effects is a critical and valuable component, containing information on the effectiveness of treatments, duration of treatment trials and the populations included in trials – information we need to know to judge the potential benefit of treatments for the person sitting in our consulting room.

The publication of the guideline may turn out to be a significant moment of change in the way we practice and are encouraged to practice, though there’s no doubt it will be an evolving area for years to come.

Readers' comments (2)

  • Hopefully most of us have the common sense to practice in this way before such guidance.

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  • You over state the importance of NICE guidance. It's obvious to any GP with half a brain you couldn't implement every NICE guideline in full and to the letter for individuals with multiple pathologies. It would be bad practice, completely against the ethos of a holistic approach, and probably frequently cruel. To suggest this guideline represents a 'significant moment of change' is sad indeed. Do you believe we simply mindless technicians slavishly following NICE protocol?? Give me a break. NICE isn't the be all and end all and we should stop treating it as such.

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