When choosing to veer from published guidelines, clinicians must ensure that these recommendations are based on “justified belief,” according to an article published in the AMA Journal of Ethics.

In their article, authors Beth A. Lown, MD, and Karen E. Victor, MD, both of Mount Auburn Hospital in Cambridge, Massachusetts, describe how physicians may find it necessary to offer their patients’ treatment recommendations that deviate from clinical guidelines.

Drs Lown and Victor describe the case of a 50-year-old male patient who presented to a rural hospital with elevated low-density lipoprotein and total cholesterol levels as well as lower-than-normal high-density lipoprotein cholesterol despite 6-month changes to lifestyle. The physician chose not to recommend statin medications because he and his previous patients had experienced side effects following use of the cholesterol-lowering medications. The physician told the patient that these drugs are recommended by the American Heart Association but he does not prescribe them to his patients.

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The authors suggest a shared decision-making model between physician and patient should be adhered to in situations when a physician’s opinion differs from national clinical guidelines. Patients should understand nationally recognized recommendations for the treatment of their disease or disorder. Patients can then weigh this information with their physician’s experience-based advice to determine an appropriate treatment strategy. Patients should also be aware of alternative treatment options that have evidence to support their use.

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“In summary, in cases in which physicians recommend deviating from a guideline, they are obligated to ensure, to the best of their ability, that their recommendations are based on justified belief, not driven by bias or conflict of interest,” the authors concluded. “They are obligated to present clear information about risks and benefits of available treatment options and alternatives to patients. Physicians and patients may then share the responsibility to reach agreement on decisions that are best for the patient.”


Lown BA, Victor KE. Should a physician offer recommendations based on experience but contrary to current practice guidelines? AMA J Ethics. 2018;20(11):E1007-E1016.