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I think our role is to be informed by guidelines and to help co-create meaning with our patients.1 I do not see a fundamental conflict between these actions, and it is not clear to me that one has greater value than the other in maintaining patient safety.
For example, if the patient’s condition is ill-defined, as it often is, and the patient’s view is different from the doctor’s, as it often is, then the application of guidelines may do more harm than good. On the other hand, if the patient and doctor have reached a shared understanding of the situation, then the availability of guidelines can be helpful to both, since it is hard to know all the management options for every condition we encounter.
Furthermore, it’s not as if there is a single guideline for every condition, and often working out the most applicable elements of multiple guidelines is part of the shared therapeutic journey. Working out how to apply the best available medical evidence in the context of an individual patient (relationship) makes our work intellectually stimulating and (inter-) personally rewarding. That’s the job I’ve been trying to do for the past 20 years and I still can’t think of any job I would rather do more.
Notes
Competing interests
I am a partner at St Leonard’s Practice. We are enthusiasts for relationship continuity and my colleagues have published widely on the subject.
- © British Journal of General Practice 2021