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The debate goes on—What is your choice?

  • Irene Gavras
    Affiliations
    Hypertension and Atherosclerosis Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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  • Haralambos Gavras
    Correspondence
    Address for reprints: Haralambos Gavras, MD, Hypertension and Atherosclerosis Section, Boston University School of Medicine, 715 Albany Street, Boston, Massachusetts 02118
    Affiliations
    Hypertension and Atherosclerosis Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
    Search for articles by this author
      Guidelines are the quintessential evidence-based medicine. They are written by a group of experts who review and distill the evidence from the most recent clinical studies, especially the data produced by recent, large, prospectively randomized outcome trials and develop a set of recommendations based on these data. Although recommendations are not rules and their implementation is subject to clinical judgment, few nonexperts will challenge them or get around them. Those who do are pointedly asked by the patient's insurance company to justify their choice. For the busy clinicians, such as primary care physicians or nurse practitioners, the safest and most expedient approach is to stick to the guidelines.
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