Three questions to ask before using a guideline

“We need a better understanding of how to use guidelines — when they’re appropriate and when they’re not. I don’t recall ever being asked to unpick a guideline in my medical training despite using them almost daily. In a bid to resist the slow creep of guideline centred decision making, I’ve started to ask myself three questions:

  • Does the guideline apply to my patient?

  • Is the advice pragmatic?

  • Is it what my patient wants?

If the answer to any of those is no, I give myself the freedom to walk away from the guideline and to do what I think is right for the patient.”

Rammya Mathew

I wrote about this issue in my 2021 book, In Your Own Time. This book was written to help parents and professionals better understand the issues and the evidence relating to the current induction epidemic. Looks at the evidence relating to due dates, ‘post-term’, older and larger women, suspected big babies, maternal race and more.

If you’re a midwife or other birth worker who enjoys chatting about when to use and ignore guidelines, debating the deeper issues in practice and building wisdom, come and join Sara and colleagues from all over the world in one of our online courses!


Rammya Mathew: Three questions I ask before using a guideline. BMJ 2019: 364: I358
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