Incorporating Guidelines Into Clinical Practice: An Interview With Gary L. LeRoy, MD

Clinical practice guidelines (CPGs) have increasingly become institutionalized as ways to provide guidance to clinicians regarding patient care.¹ CPGs are “statements that include recommendations intended to optimize patient care.”² They are “informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options.”² According to the Institute of Medicine (IOM), “Trustworthy CPGs have the potential to reduce inappropriate practice variation.”²

While a guideline may be regarded as a mere “suggestion for behavior,” clinicians have “strong incentives to comply with these guidelines when they are issued, making adherence to them almost compulsory.”¹ Additionally, adherence to guidelines may be used as evidence of due diligence in the event of a malpractice claim.¹

Despite their advantages, many clinicians do not necessarily agree with the centrality or content of CPGs.³ Others — especially primary care physicians (PCPs) — are overwhelmed by the vast and ever-increasing numbers of guidelines issued by multiple societies, which they are expected to master and incorporate into practice, especially because the guidelines issued by specific societies focusing on specific conditions do not address the realities of patients with multiple comorbidities.^4,5

To shed light on the role of CPGs in primary care practice, MPR interviewed Gary L. LeRoy, MD, a family physician in Dayton, OH and a member of the board of directors of the American Academy of Family Physicians (AAFP). Dr LeRoy is also the associate dean for student affairs and admissions and associate professor of family medicine at Wright State University, Boonshoft School of Medicine, Dayton. Dr LeRoy serves the Dayton community through Reach Out Montgomery County, Dayton Public Schools, American Red Cross and Saint Vincent’s Homeless Shelter. He is the president of Dayton and Montgomery County Public Health.

What are your perspectives on the role of CPGs in primary care?

Dr LeRoy

Today’s guidelines are overwhelming in number and almost impossible to master. As a personal family physician, if I were to read every single guideline issued by every society or medical institution, along with my other daily responsibilities, it would be like reading all 8 volumes of Harry Potter every single day. It is virtually impossible for PCPs to read and master all of these recommendations, so as in other areas of medicine, one must triage the guidelines based on what is most immediate and relevant to one’s practice.