Expert Consensus Guideline SeriesTreatment Guidelines to Answer the Most Difficult Questions Facing CliniciansWhy Expert Consensus Guidelines?How often have you wished that there was an expert on hand to advise you about how best to help a patient who is not responding well to treatment or is having a serious complication? Unfortunately, an expert is usually not at hand and, even if a consultation were available, how would you know that any one expert opinion represents the best judgment of our entire field? This is why we began the Expert Consensus Guidelines Series. Our practical clinical guidelines for treating the major mental disorders are based on a wide survey of the best expert opinion and are meant to be of immediate help to you in your everyday clinical work. How do the Expert Consensus Guidelines relate to (and differ from) other guidelines that are already available?Each of our guidelines builds upon existing guidelines but goes beyond them in a number of ways:
Why should we base treatment decisions on expert consensus instead of relevant treatment studies in the research literature and evidence-based guidelines?There are three reasons why expert consensus remains an important addition:
For all these reasons, the aggregation of expert opinion is a crucial bridge between the clinical research literature and clinical practice. How valid are the expert opinions provided in these guidelines, and how much can I trust the recommendations?We should be better able to answer this question when our current research projects on guideline implementation are completed.For now, the honest answer is that we simply don't know. Expert opinion must always be subject to the corrections provided by the advance of science. Moreover, precisely because we asked the experts about the most difficult questions facing you in clinical practice, many of their recommendations must inevitably be based on incomplete research information and may have to be revised as we learn more. Despite this, the aggregation of the universe of expert opinion is often the best tool we have to develop guideline recommendations. Certainly the quantification of the opinions of a large number of experts is likely to be much more trustworthy than the opinions of any small group of experts or of any single person. Why should I use treatment guidelines?First, no matter how skillful or artful any of us may be, there are frequent occasions when we feel the need for expert guidance and external validation of our clinical experience. Second, our field is becoming standardized at an ever more rapid pace. The only question is, who will be setting the standards? We believe that practice guidelines should be based on the very best in clinical and research opinion. Otherwise, they will be dominated by other less clinical and less scientific goals (e.g., pure cost reduction, bureaucratic simplicity). Third, it should be of some comfort to anyone concerned about losing clinical art under the avalanche of guidelines that the complex specificity of clinical practice will always require close attention to the individual clinical situation. Guidelines can provide useful information but are never a substitute for good clinical judgment and common sense. Our guidelines are already being used throughout the country and seem to be helpful not only to clinicians but also to policy makers, administrators, case managers, mental health educators, patient advocates, and clinical and health services researchers. Ultimately, of course, the purpose of this whole enterprise is to do whatever we can to improve the lives of our patients. It is our hope that the expert advice provided in these guidelines will make our treatments ever more specific and effective.
Page last modified 1/20/06
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