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Why I would not relish another computer switch

The recent NICE guidance on dyspepsia downgrading the place of age over 55 as a red flag in itself underlines the weakness of guidelines as a tool for achieving good clinical practice.

First, they are so numerous it is increasingly unlikely a doctor has either the time to read and remember them all or to find them during the consultation.

Second, guidelines tend to discourage or blunt the careful analysis of the story presented by the patient.

In a patient of any age presenting to me with dyspeptic symptoms my first question is how long have they had them and I then press them to consider whether there has been any change in the character, duration or onset of the symptoms compared with previous episodes.

If there has not I am confident in treating them symptomatically.

If there has, even if it is quite subtle, I am alert to the possibility of serious underlying disease having developed.

In all cases one should be aware of the possibility of complications such as anaemia or weigh loss developing and investigate accordingly.

Do complex guidelines add much to a careful consideration of the patient's history? I am not sure but I doubt it.

I remember older doctors telling me in the past 'listen to the patient, they are telling you the diagnosis'. We forget this at our and, much more importantly, the patient's peril.

Dr Michael Blackmore



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