The mystery surrounding a physician’s knowledge of medicine has slowly dissipated with the progress of widely available information online, and people’s increased interest in participating in their own healthcare. Gone are the days when most people simply “Do what the doctor says.” Today’s typical patient questions, does research, and seeks the most qualified healthcare providers before considering medical treatments.

The medical community collectively agrees that transparency leads to best healthcare practices across the board and that physicians who participate heavily in the sharing of collective research, and developments, have been shown to deliver improved patient satisfaction over providers who rely solely on a limited circle of peers, their own clinical experience, and training.

Transparency in Practice

Modern medicine demands transparency across the healthcare spectrum. This requires the participation of healthcare providers to share information, and best practices.

Patients want complete transparency in the decision-making process. This is especially important when complex medical decisions are involved, such as when a patient is diagnosed with a serious illness. Studies show patients trust physicians who disclose more information, and that patient outcomes improve as a result.

Although clinical practice is largely based on training and experience, updated practice guidelines and a continual review of new medical literature often form the basis upon which many physicians modify or improve their clinical practice. Staying up-to-date with new clinical studies and clinical practice guidelines can be challenging, but necessary for physicians. Developing a transparent clinical practice guideline is an arduous task that may often rely on a panel of experts in the field who volunteer their expertise and time to develop guidelines for best practices. Although it is time consuming, this collaboration is pivotal in transparency.

The success in providing patients with increased access to medical information has been well documented. Patients have an interest in seeing their test results, provider notes, and hospitalization records. Well-informed patients are more likely to pose pertinent questions, making a short visit with a physician more productive. Providing full patient access to their own medical information, either by way educational brochures or online patient portals, provides greater transparency that holds proven benefits.

The ability to have an in-depth discussion regarding their medical care with healthcare staff can also lead to a better understanding of their conditions and treatment options, as well as risks, benefits, and potential complications. These shared decision-making tools are especially valuable as they allow a patient to comprehensively review the pros and cons of competing treatment options and consider their personal values and preferences with decision making choices.

When making complex decisions, patients who are fully informed, either prior to, or during a visit with a healthcare provider can greatly reduce the anxiety associated with making a complex health-related decision as can a few additional minutes with a provider to answer pertinent questions.

Patients who feel their provider is knowledgeable and transparent are more likely to trust their physician and have confidence in the decisions they make regarding their treatment options, independent of the subsequent outcomes.

Hospitalizations and Patient Information

Improving transparency at the hospital level can benefit healthcare organizations and patients in a multitude of ways. Hospital safety records, provider expertise, and how the assessment of the facility is made is important to patients. Disclosing the overall complication rates for the most performed procedures for a facility, and how their results compare with other healthcare institutions is information that patients want.

The reporting of a variety of common measures such as outcomes after surgical procedures, infections rates, and lengths of stay for different types of hospitalizations can give patients access to evaluating where and how to choose a healthcare provider. Reviewing and acting on this information in-house can provide organizations with paths to identifying their facility’s strengths and weaknesses that can lead to improvements in policy and standards of care.

Evolution of Evidence-Based Medicine

Updated clinical research studies provide deep insights to improved care options using comprehensive evidence. As technology and medicine evolves, much of what we thought we knew about healthcare in the past has been found to be either incorrect or requires some modification. Physicians update and adapt their own clinical practices with information provided from guideline resources, and a continuous review of new information published in medical literature.

Evidence-based medicine is based on clinical training and experience. However, practice guidelines are largely the basis upon which many physicians modify or improve their clinical practice, and implementing comprehensive clinical practice guidelines works to reduce the unwarranted variations in care. This promotes consistent, comprehensive care and improved patient outcomes as well as higher patient satisfaction. Because physicians base medical decisions for their patients using these updated clinical practice guidelines, there is the assumption that they are based on the best evidence that is available for the effective diagnosis and management of a specific condition. Clinical practice guidelines strive to reduce unnecessary variations in care, resulting in more consistent, efficient, and high-quality care.

Some national and international clinical practice guidelines have issued conflicting recommendations for clinical care. These differences occur in the translation of evidence into practical recommendations for the target audience. The ultimate challenge for health care providers seeking the highest quality in evidence-based clinical practice guidelines lies in the consistency in the quality of the evidence supporting the recommendations.

Scientific Critical Reviews for Clarity and Transparency

The Institute of Medicine (National Academy of Medicine) sets standards for the development of clinical practice guidelines, which are designed to be followed with the addition of point-of-care tools, online medical textbooks, and newsletters. The Institute established eight standards for creating trustworthy clinical practice guidelines in 2011 in response to concerns about clarifying and implementing practice recommendations. These standards address healthcare transparency, managing conflict of interests, following guideline developments, and group composition guidelines, as well as utilizing systematic reviews, and information updates.

The components of transparency outlined in the report also include utilizing transparency regarding key factors that determine quality and delineation of evidence, the methodology used to analyze the evidence, clinical expertise input, as well as the values and preferences of patients to develop recommendations. Additionally included is a statement regarding the structure of the clinical practice guideline development team, regarding clinical expertise, potential financial and intellectual conflicts of interest, and a disclosure of funding sources.

Tools designed to assess the quality of existing guidelines include The Appraisal of Guidelines Research and Evaluation (AGREE II), ADAPTE Collaboration, and the GRADE approach.

 ADAPTE is an international collaboration of researchers, guideline developers, and implementers focused on promoting the development and utilization of clinical practice guidelines. ADAPTE provides a structured approach to adapting pre-existing clinical practice guidelines as an alternative to creating new clinical practice guidelines.

GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach is a methodological approach for making recommendations that involves assessing the quality of evidence and implementing an evidence-to-decision framework. It is based on a balance between desired and undesirable outcomes of diagnostic and therapeutic interventions. GRADE is a systematic and transparent way to rate the certainty of evidence in reviews of clinical practice guidelines and determine the strength of clinical practice recommendations. Utilizing this approach can reduce practitioner bias and create consistency when determining benefit vs. harm. GRADE can also work to clarify the evidence used to support a recommendation, acknowledgement of patients’ values and preferences, and is a transparent way of moving from the evaluation of available evidence to making a recommendation.

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