Professional Practice, Guidelines and Evidence-Based Care
Consent, capacity and candour
Valid consent requires capacity, adequate information and voluntariness. Following Montgomery, the standard is the patient's perspective: disclose material risks that a reasonable person in their position would want to know, including alternatives and the option of doing nothing. Assume capacity unless there is evidence otherwise (Mental Capacity Act 2005: understand, retain, weigh, communicate); act in best interests when capacity is absent. The duty of candour requires open disclosure when harm occurs.
Evidence-based practice
EBM integrates best evidence, clinical expertise and patient values. Know the hierarchy: systematic reviews of randomised trials for intervention, cohort studies for prognosis and harm, cross-sectional studies for diagnostic accuracy. Appraise with a focused question (PICO) and judge effect size, precision and applicability - not statistical significance alone. NNT equals 1 divided by the absolute risk reduction. Guidelines such as NICE and SIGN translate evidence but still need local adaptation; AGREE II assesses guideline quality.
Governance and traps
Audit measures practice against a standard and closes the loop; research generates new knowledge - do not conflate them. Keep records contemporaneous, factual and attributable; handle data under GDPR and confidentiality rules. Traps include presenting a small but statistically significant effect as clinically important, relying on surrogate endpoints, ignoring conflicts of interest, and assuming a guideline overrides individual patient values.
Worked example
A trial reduces events from 10% to 6%: the ARR is 4% and the NNT is 25. Even with 4,000 participants and a narrow confidence interval, the effect is modest - decide with the patient whether a 4-percentage-point gain justifies the burden and potential harms.