Clinical Practice Guidelines as Part of Evidence-Based Medicine and Related Legal Implications: An Analysis
Bibliographic record
Abstract
‘Evidence-based medicine (EBM)’ describes the application of the best available scientific evidence in the treatment of patients. It is defined by the integration of best available research evidence with clinical expertise and patient values. A product of EBM is ‘clinical practice guidelines (CPG).’ Such guidelines include statements, informed by a systematic review of evidence, that outline recommendations to optimise patient care. The main focus of the present research is the use of clinical guidelines as a ‘standard of care’ in the context of medical malpractice litigation. Major challenges associated with the use of such guidelines include the multiplicity of guidelines for a given condition, and multimorbidity in patients (whereas guidelines typically address a single condition). Rigid adherence to CPG may also contribute to the erosion of professional autonomy and the development of ‘cookbook medicine’. Furthermore, concerning liability, the developers of such guidelines may be held indirectly liable, alongside professional caregivers, for harm incurred by patients. This paper adopts a qualitative methodology, including descriptive and critical analysis of the literature and case laws. Its findings recognise the potential of clinical guidelines to promote uniformity provided that ‘competent medical practice’, based on relevance, reliability, and authenticity, can overcome the issue of multiplicity. However, strict adherence to such guidelines is associated with the erosion of professional autonomy and professional judgement.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot 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.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.076 | 0.329 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.022 | 0.043 |
| Science and technology studies | 0.004 | 0.005 |
| Scholarly communication | 0.011 | 0.011 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.005 | 0.005 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
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".