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2016年4月6日，美国《梅奥医院学报》（Mayo Clinic Proceedings）在线发表了美国贝勒医学院、迈克尔·德贝基（Michael E. DeBakey）退伍军人医疗中心丹尼尔·穆舍尔（Daniel M. Musher）关于委员会是否应该编写指南和建议发表不同意见的文章，对例如乳腺癌或前列腺筛查指南等存在的问题发表了看法。 Mayo Clin Proc. 2016 Apr 6. [Epub ahead of print] Should Committees That Write Guidelines and Recommendations Publish Dissenting Opinions? Musher DM. Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine; Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX. Medical guidelines tend to convey a sense of unanimity of opinion that may not reflect the deliberations of the experts who wrote them. Using, as an example, an analysis of the recently published recommendations on administering pneumococcal conjugate vaccine to adults, the present article raises the question of whether official recommendations and guidelines should include dissenting opinions, analogous to decisions issued by the US Supreme Court. The argument that such a policy would lead to confusion in our profession is addressed in 2 ways: (1) the current system, in which different professional societies publish conflicting recommendations, as in the case of breast or prostate cancer screening, can be far more confusing, and (2) in the long run, greater transparency will lead to more thoughtful and higher-quality medical care. Perhaps the most important point of this paper is the suggestion that it is far better to bring dissent into the recommendation process than to act as if it is not there. PMID: 27061767 PII: S0025-6196(16)00074-4 DOI: 10.1016/j.mayocp.2016.01.018 |
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