Conflicting information: some thoughts
Know the limitations of your
resources
It is important to understand
the limitations of different resources so that when faced with conflicting
information you can decide which course of action to follow. For example, there may be
important differences in information about doses and indications between UK and US
sources because of variations in marketing authorisations or accepted practice.
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Information about using
medicines in patients with co-morbidities in SmPCs may be quite cautious when
compared to sources based partly on expert opinion such as the Maudsley
Guidelines and the Psychotropic Drug Directory. The SmPC has to reflect the
experience that the manufacturer has been able to gain with the medicine in
clinical trials. For example, an SmPC will almost always
advise against the use of a medicine in pregnancy, but
specialist resources may be better able guide your decision-making by drawing
on other sources of information.
Sometimes official guidance such
as that from the UK Health Security Agency or the MHRA may differ (and even override) information in
SmPCs and the BNF.
Breaking news
Faced with conflicting information,
think about whether new evidence or guidance may have been published which may explain the differences you find. Most books are probably a
couple of years out-of-date when they are published – could this account for
some different advice you've encountered? Even online resources can be
updated fairly haphazardly – for example SmPCs don’t always incorporate new MHRA
safety warnings immediately, and sometimes there can be a significant delay – could
this explain your findings?
Getting to the bottom of things
If they are available,
consult the reference lists of the publications you have used – do the resources
vary in the evidence upon which they have based their conclusions? Could this
account for the conflicting advice? Even using the same evidence, different
experts may come to different conclusions. If necessary track down the original
papers and make your own decision with your patient in mind.
Reaching the consensus
Is one of your resources at
odds with everything else you are finding? Remember that the answer you provide
should usually represent the consensus of opinion, and you will need to keep
checking different resources until you get a feel for what the majority
recommend.
Making the decision
Having worked through all of
the steps above you hopefully will have worked out why your resources are giving
you different messages and you’ve been able to make a decision about your
individual patient. In discussing your findings with the consultant, and
ideally the patient as well, you may need to highlight the differences you’ve
encountered and justify your recommendations. As always, don't be afraid to ask for help if you need it, and you should consider documenting your decision and the reason(s) for it.
