Contrary to popular belief, the care patients receive for PD, and most other conditions, varies from physician to physician. Medicine comes from science. Nevertheless, it is also an art. Physicians prescribe treatments based on their opinions, and best judgments. Just like politics, people form their opinions based on their different backgrounds and experiences. Medicine is no different. A physician trained at Massachusetts General Hospital is likely to learn from different material, and adopt some different practices and techniques than a physician trained at Johns Hopkins University Hospital, a few states away. Furthermore, there are volumes of scientific studies that physicians consider. Believe it or not, there is quite a bit of disagreement in that literature. The PD community fosters a few good debates about science, drugs, patient care and many other issues. In the case of these PD guidelines, the American Academy of Neurology brought a group of six prominent PD specialists together. They reviewed virtually all of the literature, and identified the techniques, treatments and practices with the strongest scientific support for improving the lives of PWPs. Treatment guidelines are helpful because they usually represent the strongest scientific proof, and sound patient care experiences. However, many physicians shy away from them. Some physicians have referred to clinical practice guidelines as “cookbook medicine.” What they frequently mean is:
- Clinical practice guidelines encourage physicians to think narrowly. This is not to the patient’s advantage because guidelines may overlook the unique circumstances of some patients’ illnesses.
- Clinical practice guidelines may interfere with physicians’ instincts. Sometimes, physicians find the ideal diagnosis by experimenting. This is the artistic part of medicine. In addition, physicians’ hunches and instincts often lead them to treatments that work well for a particular situation. Clinical practice guidelines may dull the instincts of many effective physicians.
There are physicians who treat many PWPs, such as movement disorders specialists, that will read the guidelines and adopt new or better practices. However, the audience for the guidelines is likely more general. Imagine a small city, or a town where there are just one or two neurologists. They see patients with a broad range of neurological challenges. Perhaps, they see two or three patients with Parkinson’s each day. They do not have the same level of experience as a neurologist in a large city who chooses to focuses 70% of their practice on PD. Clinical practice guidelines provide general neurologists a new resource of expertise. The guidelines help them sort through and identify the best science. Emergency room physicians, primary care physicians, and hospitalists (physicians that only treat patients that are admitted to the hospital) will use the guidelines to treat a PWP. They can access the clinical practice guideline at their fingertips – instant expertise. Surely this information enhances nurses, respiratory therapists and other health care professional’s ability to provide for the needs of PWPs. The biggest winners in the rollout of clinical guidelines are patients and caregivers. Each version of the clinical practice guideline has a section for patients and caregivers. It simplifies the clinical jargon. Click here to access the list of the new clinical guidelines. The current guidelines focus on diagnosis and early onset, neuroprotection, and complications such as dementia and depression. As you read through the guidelines, be sure and watch for the difference between a few key phrases:
- Strong evidence = More than one high-quality scientific study
- Good evidence = At least one high-quality scientific study or two or more studies of a lesser quality
- Weak evidence = The studies while favorable are weak in design or strength of the evidence
- Not enough evidence = Either different studies have come to conflicting results or there are no studies of reasonable quality
