Thursday, October 13, 2011

Family physicians and the Goldilocks principle

A recent national survey of internal medicine and family physicians published in the Archives of Internal Medicine found that 42 percent of physicians felt that their patients were getting "too much" health care, while only 6 percent thought that patients were receiving "too little." These opinions contrast with multiple previous studies showing that primary care clinicians fall short when it comes to providing guideline-recommended care; a 2007 study, for example, found that children received less than half of indicated care.

So which is it: too much care, too little, or some of both? And how can AFP help family physicians avoid these extremes and strive for the happy medium, which in other fields is known as the "Goldilocks Principle"? In addition to bringing readers the latest Practice Guideline updates, such as the Centers for Disease Control and Prevention's 2011-12 recommendations for influenza vaccination, we provide information that allows you to evaluate these guidelines against the best design criteria previously proposed by AFP Deputy Editor Mark Ebell, MD, MS:

The best guidelines share several characteristics: they begin with a comprehensive review of the literature; they carefully assess the quality of the literature to identify the best studies; they base their recommendations on the best studies; and they tell us the strength of the evidence that supports each key clinical recommendation. In other words, they are founded on the principles of evidence-based medicine, which strives to make decisions on the best available information—“best” implying that the evidence is graded, so that one has a sense of what is good evidence and what is not, and “available” implying that the literature search is comprehensive. Transparency is the key: readers should know why each recommendation is made and whether it represents opinion, theory, or fact. Finally, guidelines should be independent of industry support (an all-too-common occurrence) and should clearly identify any potential conflicts of interest of the authors. Ideally, guideline authors should have no conflicts of interest, which can diminish the quality and validity of the guideline.

There are, of course, many reasons - financial, medical-legal, and practical, to name a few - that care may diverge from that supported by the best evidence-based guidelines. Still, we hope that every section of the journal makes it easier for family physicians to provide care that is "just right."


The above post was first published on the AFP Community Blog.


  1. After reading this insightful post, it is clear that patients have a completely different priority/perspective than physicians. This disparity needs a further analysis. I don't think bringing the latest guidelines is necessarily the best approach since there is an increasing loss of confidence in current governmental entities as far as institutional conflict of interest is concerned. I prefer to upregulate my immune system nutritionally rather than pharmaceutically. This is one reason I rarely see my doctor. The last time he wanted to put me on statins when most of the long-term epidemiological data indicate reduced all cause mortality with cholesterol levels between 5.0-5.9 mmol/ml. So much for practice guidelines as far as I am concerned. Now I look at the data myself before consulting with a doctor.

  2. It would definitely give you a enormous healthcare benefits to go to a family doctor who understands of the existence or lack of this risk factor for you and your household. Main proper care health professionals are generalists who are often the first to see/diagnose people.