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Record W2103269114 · doi:10.1093/clinchem/48.1.9

Practice Guidelines and Practicing Physicians—Who’s Guiding Whom?

2002· editorial· en· W2103269114 on OpenAlexaff
Carl van Walraven

Bibliographic record

VenueClinical Chemistry · 2002
Typeeditorial
Languageen
FieldMedicine
TopicClinical practice guidelines implementation
Canadian institutionsInstitute for Clinical Evaluative SciencesUniversity of Ottawa
Fundersnot available
KeywordsMedicineFamily medicineMedical education

Abstract

fetched live from OpenAlex

When I was a medical student, I had a medicine rotation with a spectacular senior resident and a less than stellar staffperson. The resident was very smart, terrifically organized, and ran the service extremely efficiently. The staffperson had probably spent too much time away from clinical medicine. I distinctly remember team rounds in which our resident would present cases such that the staffperson appeared to make the big decisions (“I was uncertain what to do but thought that you would likely get a bone marrow biopsy”, to which the staffperson would usually nod and muse, “Good plan”). As a student, I was struck by the irony of a resident guiding the staffperson. Now that I am a staffperson, who probably spends too much time away from clinical medicine, I am struck by how cunning the staffperson was to listen carefully to the resident and accept the valid decisions. Like a wise staffperson, guidelines are supposed to help physicians practice best medicine within an environment containing an ever-increasing volume of information. Although guidelines have been successful in changing physician practice (1)(2), they have not always been successful in modifying laboratory utilization (3). There are many possible reasons to explain this. Not all physicians receive, read, or agree with particular guidelines. Because it is impossible for guidelines to consider all variations in patient populations and physician practice styles, dissonance between guideline recommendations and actual practice will always exist. Finally, information contained in guidelines has often been disseminated through other routes and has already modified the practice of receptive physicians.

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.014
metaresearch head score (Gemma)0.060
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesMetaresearch
Consensus categoriesnone
DomainCandidate signal: Methods · Consensus signal: none
Study designCandidate signal: Not applicable · Consensus signal: Not applicable
GenreCandidate signal: Editorial · Consensus signal: Editorial
Teacher disagreement score0.986
Threshold uncertainty score0.076

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.0140.060
Meta-epidemiology (narrow)0.0040.002
Meta-epidemiology (broad)0.0040.002
Bibliometrics0.0030.003
Science and technology studies0.0030.005
Scholarly communication0.0090.008
Open science0.0050.001
Research integrity0.0260.047
Insufficient payload (model declined to judge)0.0070.010

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.357
GPT teacher head0.560
Teacher spread0.203 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

Study designNot applicable
DomainMethods
GenreEditorial

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations18
Published2002
Admission routes1
Has abstractyes

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