Medical Guidelines

Professional bodies

For all doctors in the UK, in addition to the guidelines that have to be followed on pain of professional censure there are additional guidelines regarding standards issued by specialist professional bodies. In the UK, for anaesthesia these are the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists GB and Ireland (AAGBI). 1 2 Similar organisations with similar functions exist in other countries.

Guidance and standards documents are always subject to revision and rewrites. Furthermore a balance must be struck between expert opinion and evidence, and satisfactory and excellent standards. No best practice guideline can replace the need for experienced clinical judgement exercised by individual anaesthetists in the best interests of their patients, but they are very much intended to support this. 3 An additional source of best practice asks that individual anaesthetists report their experience and outcomes to a committee where the information is retained on a common database thus allowing other clinicians encountering unusual cases to determine the best course of treatment. 4 Similar national databases are maintained and report anonymously on unexpected perioperative deaths (NCEPOD). 5 A report with appropriate recommendations is then compiled and guidelines, designed to prevent similar occurrences are then published.


National bodies

The national institute for health and care excellence (NICE) describes itself as follows: “We provide independent, authoritative and evidence-based guidance on the most effective ways to prevent, diagnose and treat disease and ill health, reducing inequalities and variation.” They state that their quality standards are based on concise sets of prioritised statements. They are designed to drive measurable quality improvements within a particular area of health or care. They are derived from the best available evidence such as NICE guidance and other evidence sources accredited by NICE. They claim they are developed independently by NICE, in collaboration with health and social care professionals, their partners and service users. 1 All doctors are expected to be convergent with subject matter that important to their specialty.

However not all doctors agree that NICE is as independent as they claim nor that they base their guidelines on the best available evidence. 2 Clinical Commissioning Groups, (CCG) who decide which treatment they will fund, and thus which patients doctors can treat, are obliged to follow some NICE advice. Recently this has also been applied to clinical guidance and doctors may not ignore it simply because they disagree with a treatment. A has court ruled that the CCG was under an obligation in public law to have regard for the NICE guidance and to provide clear reasons for any general policy that does not follow NICE guidance. 3 In the US the equivalent organisation is The Agency for Healthcare Research and Quality’s (AHRQ). Its mission is

“to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used.” 4


Medical practitioners

The General Medical Council in the UK maintains a list of registered medical practitioners. Being on that register informs the public that you have reached an expected standard and you can most likely be relied upon. To remain on the register and continue to maintain their careers a doctor must comply with the standards set by “Good medical practice (2013).” 1 Failure to adhere to these standards in any one of four of these domains will result in censure or erasure from the register and possibly an end to their career.

Four domains of medical professionalism:
Domain 1: Knowledge, skills and performance
Domain 2: Safety and quality
Domain 3: Communication, partnership and teamwork
Domain 4: Maintaining trust

If a formal complaint, based on any or all of the domains, is made against a doctor he or she may have to attend a Fitness to practice panel (FTP). In a response to demands for greater transparency the names of those doctors who have had to attend a Fitness to practise panel are in maintained in the public domain. 2

In addition, each doctor has to undergo a five yearly revalidation process. Essentially they have to prove themselves in these same domains. They not only have to demonstrate they doing enough procedures per year to maintain their competencies but also demonstrate evidence they are keeping up with developments. Finally they have to submit the outcome of 360-degree appraisal by peers, colleagues, managers and others they interact with, including patients. Thus the meaning of being a professional is that if you fail to reach an agreed standard you lose your livelihood. A list of worldwide organisations equivalent to the UK’s General medical council can be found here:


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