Guidelines: From a “Can” to “Ought” and “Should” and Back Again – Results on the Way of Doctoring
DOI: 10.3238/zfa.2014.0256-0260german translation / full article
Summary: 20 years of guideline-history are reflected on base of personal experience and involvement. A development towards directives as part of the guidelines („ought“, „ should“) and, with it, an nearly legal impowerishment concerning the necessities in concrete decision-making for and with a patient are reached today. This is due to an unrealistic faith in “methodological good studies” as well as a rejection of all knowledge stemming from less solid, e.g. register or pathophysiological studies and the experience of doctors. Supported was this development by health policies towards quality assurance and quality-indicators. At the end, and again on base of clinical-epidemiological studies showing the multidimensional world of influences on the course of disease, acceptance that there is no “right” or “wrong” for all decisions concerning patients has grown again. Guidelines once again have started to describe corridors for acting without using the terminology of directves.