To the Editor: Clinical pathways and guidelines are the inevitable consequence of evidence-based medicine and, in general, have been a force for good in terms of patient care. However, the experiences of Nanan et al1 and Dietz and Stokes,2 and my own experience of working with countless exasperated colleagues in clinical practice, suggest that the pendulum may have swung too far towards uniformity of care.
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- 1. Nanan RK, Poulton AS, Champion BL. Clinical pathways: a departure from the art of medicine. Med J Aust 2012; 196: 96. <MJA full text>
- 2. Dietz HP, Stokes BJ. A plea for professional independence. Med J Aust 2012; 196: 104-105. <MJA full text>
- 3. Sackett DL, Straus SE, Richardson WS, et al. Evidence-based medicine: how to practice and teach EBM. 2nd ed. Edinburgh: Churchill Livingstone, 2000.
- 4. Douglas Bader Foundation. Some quotes from Sir Douglas Bader. http://douglasbaderfoundation. com/2010/10/15/some-quotes-from-sir-douglas-bader/ (accessed Mar 2012).
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I am head of a clinical obstetrics and gynaecology service (Osborne Park Hospital, Perth) and a Fellow of the Australasian Association for Quality in Health Care. I have written guidelines and I run a medical student workshop on evidence-based medicine theory and practice.