Abstract: The AHCPR Incontinence Guideline: Politically Correct or Practical Medicine?

Kevin R. Loughlin, MD, ed. "The AHCPR Incontinence Guideline: Politically correct or practical medicine?" Contemporary Urology (December 1996).

Objectives:
* Dr. Jerry G. Blaivas and Dr. Thomas J. Rohner, Jr. debate whether the AHCPR Incontinence Guideline represents politically correct medicine or good practice. Dr. Blaivas argues that the guideline is merely politically correct, and Dr. Rohner argues that it is inherently practical. The debate is followed by a brief discussion entitled "Are guidelines always politically correct?" by editor and urologist Kevin Loughlin.

Conclusions:
* Dr. Blaivas believes the AHCPR Guideline is fatally flawed, as it recommends that patients initially be treated for incontinence by the simplest, least invasive therapies, without first obtaining an indisputable diagnosis through exhaustive urodynamic testing. Dr. Blaivas points out that the AHCPR Guideline assumes "that patients will endure one unsuccessful behavioral therapy after another, patiently waiting until finally a proper diagnosis is made and effective treatment is instituted." Dr. Blaivas asserts that such reasoning explains why urinary incontinence is underdiagnosed and undertreated: patients become frustrated and demoralized after a number of ineffective treatments, and give up, believing the myth that there is no effective treatment for incontinence.
* Dr. Rohner is concerned that urologists are performing surgery too often and too soon, and argues that urologists must do a better job of addressing their patients' incontinence needs, rather than acting merely as their surgeons. He argues that many urodynamic tests are unnecessary, and that therapy based on history, physical examination, urinalysis, and postvoid residual alone is as effective in the long-term as surgical intervention. In discussing the problem of patient access to urologists, Dr. Rohner asserts that the problem is not government guidelines, as Dr. Blaivas argued, but rather that patients are being driven away by market forces and economics. In support of the AHCPR Guideline, Dr. Rohner emphasizes that noninvasive therapies are often effective, and that while they do not always effect a permanent cure, neither does surgical therapy.
* Dr. Loughlin concludes the debate, advocating education as the only solution to the controversy discussed by Blaivas and Rohner. According to Loughlin, the public must be educated as to what constitutes good care: testing and treatment tailored to the individual patient. Loughlin asserts that urologists must also continue to educate themselves, so that they can do a better job than non-urologists in diagnosing and treating urologic dysfunction.

If you would like to read this study, please contact us and we will send a copy to you.