![]() ![]() In other words, a standard-of-care is sensitive to time, place and person. A standard-of-care is not an indication, guideline or recommendation but a duty determined by a given set of circumstances that present in a particular patient, with a specific condition, at a definite time and place. A bigger concern is use of the term standard-of-care. In medicine an indication is a valid reason for a procedure, different from a guideline or recommendation, a guide to decision making. The descriptors used in the ASCTC and other guidelines such as those of the European Group for Blood and Marrow Transplantation (EBMT), the British Society of Blood and Marrow Transplantation confuse and/or mis-use terms such as indications, guidelines, recommendations and standard-of-care. We recently discussed the role of heuristics in this process elsewhere in the Journal ( Being certain even when you’re wrong: heuristics and thin slicing in haematopoietic cell transplantation) (2) the influence of prior knowledge, even errors or deceptions on descriptors (Bayesian wine tasting?) and (3) the importance of panelist selection on internal and external validity. There are several lessons from this experiment: (1) the danger experts may miss the forest from the trees. In contrast, several novices, but not expert, commented the cabernet tasted very much like the chardonnay. Expert descriptors switched to: leather, tobacco, dark fruit flavors, plums, apricots and black pepper. The panel then reviewed a wine identified as a cabernet sauvignon but which was the same chardonnay with tasteless red dye No. Novice descriptors were more prosaic: not bad, a bit acidic, I like it etc. ![]() Descriptors used by experts included hints of pineapple, papaya, mango vanilla, spice and butter. In a well-known, often replicated wine tasting experiment, a panel of experts and novices was asked to sample and comment on an oak barrel aged chardonnay. We also discussed several definitions of experts: … somebody from out of town with slides A man who tells you a simple thing in a confused way in such a fashion as to make you feel the confusion is your fault (William Castle) and …a man who has made all the mistakes which can be made in a very narrow field (Niels Bohr). Michael Crichton) and Consensus is the quickest road to mediocrity (Mayer Rus). We also discussed diverse opinions on the value of consensus ranging from: Consensus means that lots of people say collectively what nobody believes individually (Abba Eban), Historically, the claim of consensus has been the first refuge of scoundrels it is a way to avoid debate by claiming that the matter is already settled (Dr. Such guidelines are based on respectable judgments theory that argues that views of a group have greater validity and reliability than the judgment of an individual and that systematic and explicit structured methods for developing judgments are more valuable than informal accuracy and communicability methods. In 2018, we published an article in the Journal: Is there expert consensus on consensus? in which we discussed the development of expert consensus guidelines. In reality, no one should be surprised by a critical review. ![]()
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