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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 15; 335(7619): 536.
PMCID: PMC1976502
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Patients do better when doctors follow guidelines

Doctors are notoriously bad at following guidelines. Perhaps they would do better if it was clear that following guidelines made a real difference to patient outcomes. Proving this is difficult, but in one recent study researchers did find a link between guideline based care and better outcomes for patients with depression.

They did a secondary analysis of data collected between 1996 and 1998 in three randomised trials from the US, by developing a quality indicator that measured participating primary care doctors' adherence to national guidelines. The doctors were good at recognising depression and starting treatment. They weren't so good at long term follow-up, adjusting treatment when necessary, or assessing alcohol use or patients' risk of suicide. They were particularly poor at following guidelines on the treatment of older people with depression.

The researchers found that doctors' scores on the quality indicator significantly predicted patients' scores on a modified depression scale 12, 18, and 24 months after enrolment. Better adherence was associated with fewer symptoms and a lower risk of persistent depression.

These data are old and practice has changed, says an editorial (p 342). But the principle of the study is sound: guidelines should be tested to see if they improve patients' symptoms. If they don't, they should probably be changed.


  • Ann Intern Med 2007;147:320-9

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