At this year’s Euroanaesthesia Congress #EA19, there was a short debate on the topic of guidelines. Talking about the pros was Edoardo De Robertis, Past-Chair, ESA Guidelines Committee, University of Perugia, Italy, and talking about the cons was Arash Afshari, Chair, ESA Guidelines Committee, Rigshospitalet, Copenhagen, Denmark
Here are some highlights from both sides of the debate!
Dr. Arash Afshari
“I think that it comes down to not really a question of whether or not we should have guidelines. It's a question of which format, and whether or not we actually want to implement the classical way of looking at it or we want to have really high standards for how we write and implement guidance. It all comes down to whether we should write guidelines just for the sake of for publication or do we really want to change our practice.
If the guidelines do not live up to the best standards, they may actually be misleading. So we may actually not only endanger our patients, but also misguided our colleagues. Most of it comes down to the fact that we have a lot of literature that is of poor quality. We have many traditions, not based on evidence-based medicine. It's a dogma-driven medicine across our field that has to be changed into evidence-based medicine. So it's a mind change and it is also going away from the culture of publish or perish. Many institutions are driven by the publication of academic papers without setting the standards high. One of our major issues has been how do we control the impact of conflict of interest. One of the challenges we have with some of the experts may actually be perceived as having too much conflict interests. So this is an aspect that we need to control.
It's not just a matter of writing documents. It is also about how to use these documents to change our practices and our research because that's the essential pillar of our existence. We're talking about a 500 billion U.S. dollars a year annually basically being wasted because of erroneous research. It’s a huge problem that we need to address, and that is my reservation about producing mass producing guidelines. I don't believe in mass production. I believe in higher quality. Less is more in a sense that I want higher standards for our guidelines, and smaller and more focused guidelines.”
In response, Prof. De Robertis had this to say!
“Physicians face a daily struggle. What do I have to do? Which procedure do I have to change? Which drugs do I have to use? We need evidence-based medicine, and the guidelines are a way to offer that, if they are well-developed, evidence-based medicine. Probably, most of the guidelines lack authority. They also lack decision process, and that's probably why, good guidelines that already exist, are not followed. Where there is not such strong evidence, we also have to give some clinical reasoning tool to the clinicians so that they understand why we suggest to use that procedure, and why we suggest to use a certain drug. The problem is how the guidelines are developed and how the recommendations are given. Because if the recommendation is based on a very, very, high-level evidence and if the benefit for the patients is very high, then that recommendation will be followed blindly. But there are very few guidelines like that, few recommendations like that because the literature, most of the time, is not so strict and not so clear.”
Image Credit: Euroanaesthesia 2019