prescription could be prohibitive. Others ma yvalue their life in so far as the yare
able to look after their children. Although it might be possible to ascertain the types
of consequences that are, on the whole, most important, it is impossible to
predetermine their respective value objectively.
Guidelines rel yon patient homogeneit y, that is patients being ver ysimilar. In
stroke rehabilitation, where patient variation is high, it is difficult to write a pre-
cisel ydefined clinical guideline. There are, on the other hand, areas of health care
where patient variation is much lower, the removal of wisdom teeth for example.
When this is the case guidelines can be useful.
`In conditions such as da ycase surger y, a single patient record is eas yto
introduce. In an intensive care setting, where variations are more common, a
pathwa ytogether with freehand documentation ma ybe more suitable.' [14]There ma ybe areas where guidelines are more applicable; however, this should
not be extended to areas of health care provision where guidelines ma ybe inap-
propriate. Even when patients are suffering from the same condition guidelines
should not be applied unthinkingly. Room should be made for the needs and
wants of the patient to be accommodated. It could be argued that due to the
individual nature of man ytreatment decisions, it could be difficult to produce
guidelines that reflected each patient's treatment preferences.
However, guidelines can be used in a positive wa yand could increase patients'
autonom yb yinvolving them in the ver yformulation of guidelines and setting of
standards. Patients often have ver ydifferent perspectives from the health care
professionals and soliciting their views on their health care provision could be
invaluable. The National Service Frameworks are charged with bringing together
the views of service users to determine the best wa yto provide particular services
[2] and as part of the monitoring process there will be a national patient and user
surve yto determine these perspectives. An example of involving patients is the
commissioning of The College of Health, an organisation dedicated to patient-
centred care, b ythe Ro yal College of Ph ysicians to produce patient-centred
guidelines on conditions such as rheumatoid arthritis and rehabilitation after
stroke.
Guidelines can also be distributed to patients to enable them to be better
informed. When patients enter hospital the ycan be given a cop yof the clinical
guidelines and this can indicate what should be happening during the course of
their treatment. It will give them an informed basis on which to question and
challenge their treatment provision. This model has been adopted b ya Liverpool
hospital. The guideline is explained to the patient and the yusuall yhave access to it
during their sta yin hospital [14]. The patients therefore have a document that the y
can refer back to at an ystage and so do not have to take in all the information at the
beginning of their treatment. Used in this wa yguidelines can be a useful aid to
communication between patient and health carer. This will ensure that the consent
the patient gives is based on a full understanding of what the treatment involves.
Clinical risk management ,CRM) schemes are designed to eliminate complaints
and b ygiving the patient a greater understanding and hence control over the
treatment, complaints and dissatisfaction could be reduced.
Clinical Governance 247