Should a Physician Offer Recommendations Based on Experience but Contrary to Current Practice Guidelines?

This case of a patient whose physician refuses to prescribe statins for high cholesterol raises ethical issues about a physician's decision to offer clinical recommendations contrary to current practice guidelines. Our response summarizes social forces that have led to the rise of evidence-based medicine, the development of clinical guidelines, and the evolution of the roles of physicians and patients in decision making. We conclude that there are times when a physician can justifiably make a recommendation to a patient that contravenes a current clinical guideline. In making such a recommendation, we suggest that a physician should communicate a rationale for deviating from clinical guidelines and respect a patient's autonomy. We consider the need for and limitations of clinical guidelines, numerous factors influencing shared decision making, and key ethical principles of nonmaleficence and respect for patient autonomy.