PMID- 15804125
OWN - NLM
STAT- MEDLINE
DCOM- 20050510
LR  - 20081103
IS  - 1431-7621 (Print)
IS  - 1431-7621 (Linking)
VI  - 99
IP  - 1
DP  - 2005 Feb
TI  - [Guidelines and autonomy of physician decision. A critical survey under ethical 
      aspects].
PG  - 15-23
AB  - The convergence of Diagnosis Related Groups (DRG) and Evidence-based Medicine 
      (EbM) in the present German Health Care System Reform (GMG) leads, due to time 
      constraints, to a misuse of EbM as cook-book medicine. The communication level of 
      physicians has already shifted to abstract discussions of Randomized Controlled 
      Trials (RCT) and guidelines, inducing per sea preference for pre-defined clinical 
      decisions. The inconsistencies of evidence definitions, together with the 
      overwhelming number of guidelines and providers thereof, burden medical reasoning 
      with superfluous complexity, and contributing to the development of cook-book 
      mentality. Without comprehensive trial registration of all RCTs before the start 
      of a study, a publication bias will continue to exist. In the clinical practice, 
      it is necessary to reduce the impact of study results and guidelines to a degree 
      that remains compatible with patient interests and economy. In this field, 
      prospective controlled outcome registries may provide a control for over- and 
      faulty regulation. Clinical professionalism is characterized in parallel by a 
      critical implementation of EbM and a necessary degree of independent reasoning.
FAU - Praetorius, Frank
AU  - Praetorius F
AD  - e.u.f.praetorius@t-online.de
LA  - ger
PT  - English Abstract
PT  - Journal Article
TT  - Leitlinien und arztliche Entscheidungsspielraume--Eine kritische Bestandsaufnahme 
      unter ethischem Aspekt.
PL  - Germany
TA  - Z Arztl Fortbild Qualitatssich
JT  - Zeitschrift fur arztliche Fortbildung und Qualitatssicherung
JID - 9707934
SB  - IM
MH  - Diagnosis-Related Groups/ethics/standards
MH  - Ethics, Medical
MH  - Humans
MH  - Physicians/*psychology
MH  - *Practice Guidelines as Topic
MH  - *Professional Autonomy
EDAT- 2005/04/05 09:00
MHDA- 2005/05/11 09:00
CRDT- 2005/04/05 09:00
PHST- 2005/04/05 09:00 [pubmed]
PHST- 2005/05/11 09:00 [medline]
PHST- 2005/04/05 09:00 [entrez]
PST - ppublish
SO  - Z Arztl Fortbild Qualitatssich. 2005 Feb;99(1):15-23.