“The people of this country have had enough of experts”
Michael Gove, 3 June 2016
It is a little galling after years of studying and honing your craft to be told that your expertise is not required. To be fair to Michael Gove, he claimed that he was interrupted and that he intended to qualify his statement to explain that he was speaking in regard to economists. However, I am not sure the health economists working with us in Healthcare Improvement Scotland (HIS) will think this qualification makes it better.
So I believe we have not had enough of experts. In SIGN (which is part of HIS) we rely on our multidisciplinary teams to use their expertise to critically appraise the literature and come to a considered judgement in order to inform practice. Where I have some sympathy for the quote is where we have relied on experts making statements not based on evidence who expect to be listened to simply because of their years of experience. That is precisely why we need evidence-based guidelines.
“The problem with evidence, of course, is that it is of variable quality. It may be conflicting. It may not even answer the precise question that we in Scotland consider needs to be addressed.”
The problem with evidence, of course, is that it is of variable quality. It may be conflicting. It may not even answer the precise question that we in Scotland consider needs to be addressed. This is why we need our experts, our clinicians with expertise and our patients with expertise who live with the condition to work together and apply considered judgement. Considered judgement is just one point in the process of guideline development, but one I think should not be forgotten. The phrase itself makes it clear this is a judgement, it may change if the evidence were to change or it may not apply in a particular circumstance. But unless a judgement is made then it is really difficult for practitioners and patients to act with confidence.
SIGN has a long and proud history of providing recommendations for practice in NHSScotland and for leading rigorous guideline development in the international community. For example, two members of the SIGN team recently presented our work, on asthma, on involving patients and on guidelines methodology, to an international conference in Australia.
“SIGN has a long and proud history of providing recommendations for practice in NHSScotland and for leading rigorous guideline development in the international community.”
I think our patient information booklets enable Realistic Medicine. Each guideline has a booklet for patients describing to them what is advised for their condition and enabling a meaningful conversation about their diagnosis treatment and care: “If the guideline says this, what does this mean for me..?”
I am pleased to be Chair of SIGN, I think it is a fantastic team and I want to ensure that the clinicians and patients in NHSScotland recognise this gem. Clinical practice in Scotland is not that different from the rest of the UK or our European and American colleagues but isn’t it reassuring to know that we have guidelines based on evidence which applies to the context of practice for NHSScotland?
So, Michael … This country has not has enough of experts, it needs expert assessment of evidence to address variation, bring new evidence to the forefront and support patients, their families and practitioners in their practise.
Professor Angela Timoney is Chair of the Scottish Intercollegiate Guidelines Network (SIGN), part of Healthcare Improvement Scotland.