How to use expertise rather than expert opinion in guideline development

Let’s banish the labels “expert” and “expert opinion” and learn how to appropriately use clinical expertise.

Let’s banish the labels “expert” and “expert opinion” and learn how to appropriately use clinical expertise.

So much clinical experience is not recorded, not standardized, but stored in those vast Watson brains of the individual clinicians. Use it, consider it, just don’t blindly accept concepts prefaced with, “in my experience…” as representation of general fact or evidence. The comments are offered as individual experience. Accept them as such and remember the following examples of why individual experiences are often biased.

An allergist friend of mine often complains to me that primary care docs never treat sinusitis long enough or with the right antibiotics. What does he base this opinion on? His clinical experience. He’s in a large group practice with primary care physicians. So he only sees and treats the 1-5% of sinusitis cases that are treatment failures and referred on from their primary care doc. His worldview of sinusitis treatment by primary care is built on a biased sample of patients that reflect the most serious cases. He never sees the 95-99% of cases that resolve on their own or with conservative management of their symptoms.

Similarly, an orthopedic surgeon argues that all patients who come in with knee pain require knee replacement surgery. Once again, her experience is based on a biased sample of patients who have failed all other treatment options and are referred for her surgical services. She misses all the patient successes with trials of exercise.

So if you don’t use experts for their expert opinions, how do you use them?

Use your panel’s expertise to:

  • Refine the clinical question. This will ensure that the questions you seek to answer are relevant to clinicians.
  • Help define the search terms. How many different names are there for the disease, clinical condition, interventions, etc?
  • Help define the inclusion and exclusion criteria for research selection. What populations and interventions will be in and which will be outside of the scope of your evidence review?
  • Help extract data from the studies. They’ll often find relevant data that may not be clearly labeled. And they’ll gain familiarity with the studies and what these studies are really about.
  • Develop recommendations. This is essential to be sure the recommendations are relevant to clinicians and the way they deliver care.