A ''shifting paradigm'' means balancing the interests of patients with those of academic journals, says Prof David Haslam, chairman of a prestigious health body in England.
Dr Haslam, who spoke to Dunedin clinicians this week, chairs the National Institute for Health and Care Excellence (Nice), the part of the National Health Service that advises on care, drugs and sector standards.
At the centre of often fierce health debate, Nice does not have a New Zealand equivalent.
Scientific, ''evidence-based'' healthcare must accommodate a move towards ''patient-centred care'', Prof Haslam said.
More people in England had two or more conditions than one condition, and it was often patients who best knew what they needed.
Having multiple, long-term conditions meant it was unrealistic and potentially unsafe to give all of the standard treatments for each one.
''I think we're at a really interesting moment at healthcare.
''We've had for a while this absolute focus, quite rightly, on evidence-based medicine, but we have to ally that with patient-centred medicine.''
Asked by an audience member if Nice had entered ''murky'' territory, Prof Haslam said it was possible to merge the ''two mindsets''.
''I'm much more interested in the pragmatism of getting the right thing for the population, rather than the right thing for the academic journal.''
Medical journals were important, but were not the ''be all and end all''.
Nice used patient feedback for setting guidelines, something that yielded ''horrifying'' insights at times.
He cited the example of self-harm, in which patients asked Nice to include a stipulation doctors use local anaesthetic when stitching wounds.
This had been assumed to be so obvious it did not need to be spelt out, but patients revealed that emergency doctors, often irritated with the self-harmer, stitched without anaesthetic.
Prof Haslam, a former GP, said it was important to remember clinical guidelines were not a ''cookbook'', and the doctor must apply clinical judgement to every case.
Adapting guidelines
A Dunedin health orgganisation is filling a ‘‘void'' by adapting English medical guidelines for New Zealand, Bpac NZ executive director Prof Murray Tilyard says.
New health guidelines were not being created, nor existing ones updated, since the New Zealand Guidelines Group shut down in 2012.
‘‘There was definitely a void, so we are trying to address that gap.''
Bpac NZ has formed a partnership with the National Institute for Health and Care Excellence (NICE), in England, and is adapting the NICE guidelines for New Zealand.
It is working on the first two now - the use of antibiotics for respiratory infections, and managing urinary incontinence including the appropriate use of surgical mesh in prolapse.
English guidelines had to be changed to fit local conditions, and some needed more adaptation than others. An example was the respiratory guidelines, which had to include rheumatic fever, a ‘‘Third World disease'' that did not feature in England.
‘‘We have a need in our own publications for guidelines, because general practice, primary care, is asking for them,'' Prof Tilyard said.
The guidelines would be made available for the whole health sector.
