Although one of the goals of clinical guideline development is to aid the provider with information to help make important treatment decisions, what’s not completely divulged is that clinical treatment guidelines can’t make a good treatment decision per se for an individual patient. Guidelines that are developed from studies that have been done in large populations don’t address the individual in front of you. The other important point is that the way that guidelines have traditionally been developed is to assign a higher level of evidence and importance to those published studies that have been done in a more randomized placebo-controlled specific manner. Often those studies essentially cherry-pick the populations, so that people who are studied are not the people who are seen in practice. So, the results that you get from a study in which people might have been excluded because they were too complicated is not in sync with the reality that clinicians face every day: patients are really complicated, so how do I take care of their migraine given their complications?
It certainly is important to be aware of best available published studies, and if guidelines help to provide the best available data in a synopsis-guided form to give recommendations, trust but verify. You can trust that a well-done guideline may have looked at the available literature in an appropriate standardized way, but you, in your office-based practices, need to verify that those findings actually make sense. A guideline can’t tell you exactly what a person is going to experience when they’re exposed to a treatment, and I think that means we still need to engage the clinical judgment and the skills that we have as clinicians