Clinical Microbiology, like many areas of medical practice these days is becoming increasingly dominated by guidelines. This is generally a good thing. They are usually evidence based where possible, and written by people who know (or should know) what they are doing.

However guidelines are not perfect for the following reasons:

• They are generic:- Not every case can be covered in guidelines, so generally only the most common scenarios are covered. More uncommon diseases/presentations are often free of guideline interference!
• They are conservative:- Guidelines are generally not radical in nature. If a guideline is followed and things subsequently go pear-shaped then the authors will not want anything too radical within the guideline in case there are legal implications. This is especially true for guidelines which rely on expert opinion. If you feel your patient needs a radical solution/treatment, then guidelines are not necessarily the best place to look.
• They are cohort specific:- Guidelines usually originate from specific areas, and are often based on specific patient cohorts, so they may not apply to your particular patient cohort.
• There may be conflicts of interest:- Guidelines may be written with other agendas at stake in addition to patient care. Cost, acceptability by the public and political agendas may all contribute to producing guidelines that are sub-optimal from a patient perspective.

As Healthcare professionals we are coming under increasing pressure to follow guidelines. However too much reliance on guidelines might stop us considering patients as individuals, with specific problems and specific solutions.

Is it ok not to follow guidelines sometimes?

In certain circumstances yes, absolutely, but I strongly believe that one must understand the rules fully in order to break them properly.

“Learn the rules like a pro, so you can break them like an artist”   (Pablo Picasso)

Michael