No 4- How many Guidelines or God-lines do you need to know as a GP?

Tldr (Too Long Didn’t Read) Summary

If you are training to be a GP you should probably start your own learning by reading the 370 NICE Clinical Knowledge Summaries and being aware that the ICD-10 lists thousands of conditions.

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Guidelines or God-lines?

A friend of mine, recently called what he was reading a “God-line” and it really struck me.

We are told that “guidelines” are just guidance and it is down to the individual clinician to use “their clinical judgement” to decide what they should advise each individual patient. Which is fine.

Except…

In any future exam you will be asked to take, you will not be expected to use your clinical judgement and the “advice of a guideline”. You will be expected to know the “10 Commandments of the latest God-Line” off by heart.

How many “God-lines” do you need to know?

I have spent an hour or so trying to work this out, so that I can plan my self-directed learning for the next few years.

NICE has published roughly 346 with 50 in development as of July 2021.

SIGN has approximately 158 and the RCEM has about 120.

The total is 674 God-Lines that may be relevant to GP training.

The grand total can probably be slimmed down a bit because NICE and SIGN will overlap almost entirely but with just enough difference between their treatment plans that you might need to know the differences. A significant number of the NICE guidelines will not be relevant to primary care.

NICE has already simplified their primary care guidance to 370 Clinical Knowledge Summaries (CKS).

So the good news is that if you read 1 CKS a day for the next year (and memorise it all), you might just about know enough to pass the AKT.

However, you should probably be aware that the ICD-10 includes 72,616 different disease codes and while most of these are rare or sub-groups of disease, in general practice you are exposed to an almost unlimited possible number of diseases.

You need to know what is common, know what the guidelines say and read widely, so that you are at least aware of some of the presentations of the rarer conditions.

As always, thank you for reading. I hope you found it useful. If you did or did not find it useful then please let me know why in the comments below and I will make sure my next article takes your thoughts into account.

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(Rule 3 Word count – 418, the shortest one yet).