Whether doctors have knowledge of guidelines or not appears to be unsuitable as an indicator of how guidelines are being put into practice in the clinical routine.
Taking the case of treatment by primary care physicians of three target diseases — hypertension, heart failure, and chronic coronary heart disease — in the current edition of Deutsches Ärzteblatt International (Dtsch Arztebl Int 2011; 108(5) 61-9) Ute Karbach and her coauthors investigate the relationship for physicians between knowing the guidelines and acting in compliance with them. Data on 437 physicians’ knowledge of the guidelines was collected by a questionnaire sent out by post and physicians’ compliance with the guidelines was analyzed on the basis of patient data they supplied.
Only 40% of the primary care physicians surveyed had knowledge of the cardiovascular guidelines; 60% of them show room for improvement. Nevertheless, the evaluation showed that there was no significant difference between the treatment given by physicians who had adequate knowledge of the guidelines and treatment given by those whose knowledge of the current guideline recommendations was less good.
The reservations about guidelines and the diagnostic and therapeutic measures they contain are due to the fact that primary care physicians rate their long-term relationship to the patient, and their own professional experience and intuition, very highly. By definition, however, guidelines are intended to reflect the current state of knowledge in order to assist physicians and patients in their decision making about appropriate management. The article is accompanied by an editorial on the same subject by Ina B. Kopp, Philipps University, Marburg (Dtsch Arztebl Int 2011; 108(5) 59-60).