A recent email invited me to contribute feedback to a new SIGN guideline on asthma. It came about as I have mentioned an interest in respiratory conditions, born through local necessity for a lead on the topic as well as being interested in improving therapy for our asthma and COPD patients.
Pragmatic guidelines need to work for everyone, including those who find particular fields of medicine tedious
However a tweet from the recent Retrieval Medicine conference in Glasgow got me thinking. Speakers at conferences are normally asked to declare ‘conflicts of interest’. This time Dr John Glen of the Welsh Retrieval and Transfer Service declared a ‘disinterest’ in one aspect of the spectrum of care that he provides. It was, of course, relatively tongue in cheek. However, it got me thinking about how we recruit opinion in the process of developing guidelines for clinical care: particularly where the aim is to represent the pragmatic view of regular, busy clinicians such as GPs who haven’t had the time or inclination to develop a special interest in the subject.
Whilst I am certainly no expert in respiratory medicine, and don’t really practice much beyond the bounds of any of my colleagues, I am perhaps exactly the sort of GP who shouldn’t be encouraged to contribute to this feedback. Guideline authors at least need to ensure representation from clinicians who have less time and inclination to be interested in the topic than the enthusiasts. In a typical GP day, if guidelines are to be helpful, they need to fit into the plethora of other presentations that exist in one consultation, never mind an afternoon surgery. Copperfield has already articulated this far better than I can.
Pragmatic guidelines need to work for everyone, including those who find particular fields of medicine tedious or uninspiring (we all have them), but who need to get on with it. Guideline development needs to be pragmatically all-inclusive.
Is it time we kept a register of disinterest?
Dr David Hogg is a GP on the Isle of Arran, Scotland. You can follow him on Twitter @davidrhogg