National Guidelines: What are they and is your physician using them?
How does your doctor decide to treat a certain disease? Many patients have never thought of this question, but one that deserves your consideration. Medicine is constantly changing with new research, medications, and recommendations and the medicine your doctor learned in medical school five, 10, 15 or more years ago has evolved. Because of the vast information that is available from thousands of sources your doctor probably relies on guidelines produced by a variety of organizations including the US Preventive Services Task Force, American Cancer Society, American Medical Association, among many others.
Guidelines are not meant to be strict rules to be followed by your doctor, but recommendations based on clinical evidence that was evaluated by an expert panel. Each patient should be evaluated by your physician to determine if the guidelines are appropriate, as not all individuals would benefit from all recommendations. Guidelines consider preventive or screening recommendations along with management or treatments for specific diseases, with the goal of improving medical care quality while decreasing health care costs.
It is important to remember that you may not be appropriate for all treatments due to comorbidities, allergies, health status, and severity of your disease. For instance, if you have type 2 diabetes one of the most common recommendations is the initiation of metformin but if you have severe kidney disease this would not be a good choice for you. However, other diabetic guidelines include having an annual dilated eye exam, taking daily aspirin, a hemoglobin A1c less than 7, monofilament test for your feet, LDL or bad cholesterol less than 70, stringent blood pressure control, etc. Has your doctor discussed these with you? If not, consider asking your healthcare provider what goals you should be striving for.
A good question to ask your doctor or health care provider is if they are following any national guidelines for your particular disease. This will place you and your doctor on the same page as far as disease outcome goals and help you understand your doctor’s recommendations for you. If your doctor is not following any national guidelines then consider recommending the following website http://www.guideline.gov. This is a national guideline clearinghouse website maintained by the Federal Agency for Healthcare Quality. Great resources for you as the patient include the American Diabetes Association at http://www.diabetes.org, American Cancer Society at http://www.cancer.org, American Heart Association athttp://www.heart.org, US Preventive Services Task Force at http://www.uspreventiveservicestaskforce.org/uspstopics.htm, and the Centers for Disease Control at http://www.cdc.gov.
Help your doctor take better care of you by educating yourself. Your health outcomes are a team effort and keeping up with the national guidelines is a great start.