Ethics and the Role of Guidelines in Medical Practice

Over the past three decades, evidence-based medicine (EBM)—the use of evidence from clinical studies in making decisions about the care of individual patients—has gained a stronghold in the everyday practice of medicine. EBM’s recognized limitation is that statistically significant outcomes from numbers of patients cannot predict the likelihood of an outcome for an individual patient. This gap between what has been shown to be good for the many and what may be good for the one is replete with ethical questions that this month’s authors examine and answer.

Volume 13, Number 1: 1-73 Full Issue PDF
  • From the Editor
    Jan 2011

    Catching up with Evidence-Based Medicine

    Alex Stark
    Do patients and their physicians retain the moral authority to make decisions that depart from evidence-based recommendations?
    Virtual Mentor. 2011;13(1):3-5. doi: 10.1001/virtualmentor.2011.13.1.fred1-1101.
  • Case and Commentary
    Jan 2011

    When the Evidence Isn't There: Seeking Informed Consent for New Procedures

    Peter Angelos, MD, PhD
    The physician must consider the potential benefits of the new procedure and then determine, through discussion with the patient, what value the patient places on those specific benefits.
    Virtual Mentor. 2011;13(1):6-9. doi: 10.1001/virtualmentor.2011.13.1.ccas1-1101.
  • Case and Commentary
    Jan 2011

    The Debate over Prostate Cancer Screening Guidelines

    Karen E. Hoffman, MD, MHSc, MPH and Paul L. Nguyen, MD
    Guidelines require interpretation and should not be mindlessly applied as a template of care for all patients, particularly when there are inconsistencies between clinical practice guidelines developed by medical groups.
    Virtual Mentor. 2011;13(1):10-15. doi: 10.1001/virtualmentor.2011.13.1.ccas2-1101.
  • Case and Commentary
    Jan 2011

    Responding to Patient Requests for Nonindicated Care

    John Cardasis, MD and David R. Brush, MD
    Physicians are not obligated to offer testing or treatments that are not medically indicated—even if patients demand them. This does not mean, however, that a physician should be dismissive of the patient’s concerns.
    Virtual Mentor. 2011;13(1):16-20. doi: 10.1001/virtualmentor.2011.13.1.ccas3-1101.
  • Medical Education
    Jan 2011

    Insights from Teaching Evidence-Based Medicine

    Alan Schwartz, PhD and Jordan Hupert, MD
    Teaching medical students to use evidence effectively means helping them learn to analyze the quality of evidence, apply evidence-based recommendations to their own patients, rely on other evidence experts, and appreciate the complexity of medical decision making.
    Virtual Mentor. 2011;13(1):21-24. doi: 10.1001/virtualmentor.2011.13.1.medu1-1101.
  • In the Literature
    Jan 2011

    The Limitations of Evidence-Based Medicine: Applying Population-Based Recommendations to Individual Patients

    Joshua J. Goldman and Tiffany L. Shih
    While practicing evidence-based medicine may maximize the likelihood of positive outcomes in a large population, it does not necessarily yield the best decision in a particular situation. To date, EBM proponents have not figured out how to account for patients’ differences from trial subjects, intangible factors detectable by experienced doctors, and patients’ values.
    Virtual Mentor. 2011;13(1):26-30. doi: 10.1001/virtualmentor.2011.13.1.jdsc1-1101.
  • Health Law
    Jan 2011

    The Role of Practice Guidelines in Medical Malpractice Litigation

    Timothy K. Mackey, MAS and Bryan A. Liang, MD, JD, PhD
    Studies show that clinical practice guidelines, used by an accused physician or by patients alleging a breach of standard care, have an impact on case outcomes.
    Virtual Mentor. 2011;13(1):36-41. doi: 10.1001/virtualmentor.2011.13.1.hlaw1-1101.
  • State of the Art and Science
    Jan 2011

    Health Effects of Smoking and the Benefits of Quitting

    Edward D. Gometz, MD, MS, MIA and
    An overview of the negative health effects of smoking and the benefits to be gained from quitting.
    Virtual Mentor. 2011;13(1):31-35. doi: 10.1001/virtualmentor.2011.13.1.cprl1-1101.
  • Policy Forum
    Jan 2011

    Rating Evidence in Medical Literature

    Opeyemi O. Daramola, MD and John S. Rhee, MD, MPH
    The Oxford Centre for Evidence-Based Medicine provides a scale for stratifying evidence from strongest to weakest on the basis of susceptibility to bias and the quality of study design.
    Virtual Mentor. 2011;13(1):46-51. doi: 10.1001/virtualmentor.2011.13.1.pfor2-1101.
  • Medicine and Society
    Jan 2011

    Is There Room for Art in Evidence-Based Medicine?

    Richard Colgan, MD
    Today’s great doctors are part of a long tradition of physicians who have valued the art of medicine and married attention to the patient with rigorous medical investigation.
    Virtual Mentor. 2011;13(1):52-54. doi: 10.1001/virtualmentor.2011.13.1.msoc1-1101.
  • History of Medicine
    Jan 2011

    The Origins of Evidence-Based Medicine: A Personal Perspective

    David M. Eddy, MD, PhD
    The author gives an account of his three and a half decades of work on the concept of evidence-based medicine and how it came to prominence.
    Virtual Mentor. 2011;13(1):55-60. doi: 10.1001/virtualmentor.2011.13.1.mhst1-1101.