General Practitioners in the UK are being swamped with so much guidance that it has become unmanageable and an electronic medium is needed to combat this problem, say Dr Arthur Hibble and public health colleagues from Cambridge, in this week's BMJ.
In their study undertaken at 65 practices within the Cambridge and Huntingdon Health Authority, the authors found 855 different sets of guidelines (a pile weighing 28 kg!). They define guidelines as "any written material used by a doctor or nurse in primary care to assist decision making in relation to health care, excluding medical textbooks and electronic databases". GPs manage 90 per cent of patients without referral elsewhere and therefore guidelines help them manage the difficult and complex decisions that htey make. They complain that the mass of paper they have, is unmanageable and does little to aid decision making.
Hibble and colleagues conclude that an electronic medium is needed as it would assist in searches for information, could be kept up to date and copied. However, they conclude that this would require careful management.
This message is supported by Dr Muir Gray, the Director of Research and Development at the NHS Executive Anglia and Oxford. In his linked editorial Gray writes that clinicians are caught in an information paradox. He says that the probability that a disseminated document will arrive on someone's desk the moment it is needed is "infinitesimally small" and the probability that the same document will be found three months later, when it is needed is "even smaller".
Gray suggests that what is needed is a Chief Knowledge Officer - someone who can decide what knowledge comes into the organisation; how it is distributed and what should be passed on. He says that "We have managed money and buildings and people and energy. Now we need to manage.....knowledge and know-how".
Contact:
Dr Arthur Hibble, Acting Director General Practice Postgraduate Education, General Practice Office, NHS Executive Anglia and Oxford, Fulbourn Hospital, Cambridge
Dr Muir Gray, Director of Research and Development, NHS Executive Anglia and Oxford, Oxford