Best Practises

Will Gallego writes:

Best practices aren’t universal and the use of the term without deeper consideration can be problematic. They’re straightforward, simplistic answers to difficult questions. Quick answers can at times work in our favor, a way to avoid cognitive overhead and set a clear path to a solution. In fact, we regularly need shortcuts in our day to day work to be able to function, the trade off of efficiency for thoroughness. This is unfortunately too often co-opted and overused, rendering it specious as a mantra of “don’t think, just do” or as hand waving promotion of a product over guidance on a course of action. What should be a starting point to a conversation, to give way to deeper consideration and approaches, is instead left to be short circuited in favor of an unassailable talking point. The concepts behind best practices may be sound, but as they are not ubiquitous, they should be up for debate. Our tendency to skip deeper investigation, to assume an answer is correct based on a label, makes use of the term “best practice” dangerous.

(emphasis mine)

I was thinking about this in the context of “guidelines” about the “best practises”, often enunciated by our thought leaders. The same applied to a rush of “covid-guidelines” without attribution to different practices. So much so that anything “prepended” by covid was published by the journals. Where was the peer review then?

To say that those reflected the opinion of a committee represents group think. It is not representative of a vast majority of varying practices, but often an attempt to fit the square pegs in round holes with “adjustments”. Likewise, most cases presenting in the clinic often pass through as “routine” or worked up through guidelines. Arguably, we need standardisation, but if the trial inclusion criteria was wrong at the outset? What about the genotypes? What about the patient response quantification? Who audits those results? How many patients couldn’t complete the trial criteria? Are we sure about the randomisation, especially in the multi-institutional set-ups? Was there a central repository of radiation therapy planning? Were the plans audited? These are massive overheads, and none of them present a straight clear path to absolutism. We need to be mindful of these issues before we slot the patients in specific categories (and hence the idea around best practises).