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The dramatic growth of claims of clinical negligence, the personal trauma of litigation and the possibility of disciplinary action has affected every medical practitioner. The view that “there, but for the grace of God, I might stand” is one held by many of us. Within this environment the promise held out by clinical guidelines for the investigation of symptoms and management of disease has offered some comfort, especially when linked with the need to practice evidence-based medicine. The emergence of local and national guidelines and their availability to patients through the Internet has ensured that clinical decisions will often be challenged and desperate patients and their relatives are ever more ready to seek information on the latest approaches to the management of various diseases.
Does this book provide clearcut answer to questions about the place of guidelines in the prosecution or defence of the clinician? It does not, and cannot do so because medicine cannot be practised as though it were similar to “painting by numbers”. There is still a place for the role of experience and judgement. However, that role is being eroded and no clinician can practice without the safety net of recognised guidelines within his specialty. This also means that the role of the generalist will rapidly decline.
Brian Hurwitz's book is thought-provoking and disturbing. He draws on a wide range of clinical and legal cases. Its publication is timely and it should find a place on most doctors' bedside cabinets.