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[EDITOR'S NOTES]

In the Middle of the Bell Curve

THE PHYSICIAN AND SPORTSMEDICINE - VOL 24 - NO. 3 - MARCH 96


Practice guidelines are becoming more common: A committee reaches a consensus on how to treat a given disease and then writes it down. That's good when it helps doctors who are out of date—or using marginally useful treatments—to get back into the mainstream of medicine. But guidelines are bad if they are so rigidly enforced, or the doctor is so intimidated, that he or she is unable to individualize treatment for those patients who are a bundle of complex and conflicting problems that the guidelines don't address. Thus guidelines can push all of us toward the middle of the bell curve, offering adequate but unexceptional medical care.

In this issue, editorial board member William O. Roberts, MD, agrees that this is cookbook medicine—but argues that even the best chef starts with a cookbook. "The difference between the good and the best is often the subtle use of spices," he writes. "The spice of medicine—intelligent reasoning and clinical intuition—and the art of medicine will not be supplanted by guidelines." See his guest editorial, "Practice Guidelines: A Positive Perspective.")

Meanwhile, in his article, "Practice Guidelines Take Center Court: How to Limit Liability," board member David L. Herbert, JD, cites an example of the paradox posed by guidelines. After the 1990 death of Loyola Marymount University basketball star Hank Gathers from complications of hypertrophic cardiomyopathy, the family mounted a multimillion dollar suit against—among others—his physicians, based on claims that they breached the 16th Bethesda Conference guidelines in his care. Herbert points out that guidelines are a two-edged sword: They can protect you if you use them, but if you deviate from them, you'd better be ready to defend yourself.

Look at these articles and tell us what you think. You can write us at The Physician and Sportsmedicine.

Cordially,
Richard H. Strauss, MD
Editor-in-Chief


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