The effectiveness initiative. I. Medical practice guidelines
J. D. Trobe and A. M. Fendrick
Department of Ophthalmology, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, USA.
We examined the impact of the "effectiveness initiative" and medical
practice guidelines on the practice of ophthalmology. The effectiveness
initiative asserts that much of current medical practice is unnecessary or
harmful, too costly, and unresponsive to patient desires. It promotes more
critical review of the medical literature, research on outcomes, and
stringent practice guidelines. Whereas current practice guidelines are
helpful in codifying accepted procedures, they tend to sanction
interventions of unproved value. Future guidelines will probably reject
unproved interventions, especially if they are expensive. Although such
guidelines may limit physicians' freedom of choice, they may protect them
against capricious malpractice claims and unreasonable patient
expectations.