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Improving Preventive Care Guidelines
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IN RESPONSE:
Dr. Roach believes that physicians “can and should know” the primary literature behind each topic in preventive medicine. Although I believe that his point is basically valid, there will always be physicians who cannot read and retain all of the primary literature on every topic in internal medicine. I performed a MEDLINE literature search on mammography (using mammography as a subject heading or keyword) and found 11 301 published articles published from 1966 to the present (202 articles were found after I limited the search to randomized, controlled trials). Many physicians will not be able to read and retain much of the information in these articles. In addition, articles on mammography represent a small fraction of the available knowledge base in internal medicine, and the information base is being updated constantly, with new internal medicine articles being published almost daily.
For physicians who cannot meet the daunting challenge of reading and retaining information from all of the primary sources of literature, practice guidelines, especially those based on a systematic review of the primary literature, may be a valuable source of information. Furthermore, thoughtfully developed guidelines will inform the reader about areas of controversy and uncertainty. Guidelines may complement the primary literature and be a practical solution for busy physicians trying to provide the best possible care of their patients on a day-to-day basis.
- Copyright ©2004 by the American College of Physicians
