Andrew J.Cole, Massachusetts General Hospital and Harvard Medical School, Boston;cole.andrew@mgh.harvard.edu
Gregory D. Cascino, Mayo Clinic, Rochester, MN
Submitted July 14, 2015
This letter will be co-published by Neurology and Neurology: Clinical Practice
We appreciate Dr. Krumholz and his team's hard work on the guidelines [1]
and their thoughtful response to our commentary. [2] While the perfect may
be the enemy of the good, the good is not perfect. Nonetheless, guidelines
take on the mantle of standard of care and are sometimes used by payers,
lawyers, quality and safety officers and auditors, and administrators to
bludgeon thoughtful physicians who come to alternative conclusions. Our
point is that guidelines are frequently useful, but were not brought down
from the mountain on stone tablets, thus blind acceptance should not be
substituted for considered judgment in specific clinical situations.
1. Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline:
management of an unprovoked first seizure in adults: report of the
Guideline Development Subcommittee of the American Academy of Neurology
and the American Epilepsy Society. Neurology 2015;84:1705-1713.
2. Cole AJ, Cascino GD. First seizure management: I can see clearly now? Neurology: Clinical Practice 2015; Neurol Clin Pract 10.1212/CPJ.0000000000000151
For disclosures, contact the editorial office at journal@neurology.org.
This letter will be co-published by Neurology and Neurology: Clinical Practice
We appreciate Dr. Krumholz and his team's hard work on the guidelines [1] and their thoughtful response to our commentary. [2] While the perfect may be the enemy of the good, the good is not perfect. Nonetheless, guidelines take on the mantle of standard of care and are sometimes used by payers, lawyers, quality and safety officers and auditors, and administrators to bludgeon thoughtful physicians who come to alternative conclusions. Our point is that guidelines are frequently useful, but were not brought down from the mountain on stone tablets, thus blind acceptance should not be substituted for considered judgment in specific clinical situations.
1. Krumholz A, Wiebe S, Gronseth GS, et al. Evidence-based guideline: management of an unprovoked first seizure in adults: report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2015;84:1705-1713.
2. Cole AJ, Cascino GD. First seizure management: I can see clearly now? Neurology: Clinical Practice 2015; Neurol Clin Pract 10.1212/CPJ.0000000000000151
For disclosures, contact the editorial office at journal@neurology.org.