医学领域对指南的重视程度远超其他行业，指南能够帮助医生在面对复杂病情时作出更合理的决策。本文通过抑郁症治疗指南的例子，阐述了指南在医疗实践中的重要作用，以及它如何指导医生逐步尝试不同的治疗方案，以找到最适合患者的治疗方法。

🩺医学指南是基于最佳证据制定的算法，它们为医生提供了一套标准化的处理流程。例如，抑郁症治疗指南首先询问患者是否有双相情感障碍的症状，然后根据症状的特点推荐不同的药物，如Lexapro或Wellbutrin。

🔄指南中的步骤是迭代的，医生需要根据治疗的效果调整方案。如果初始治疗无效，则按照指南进行下一步治疗，直到找到有效的治疗方案或决定尝试更高风险的治疗。

🧬指南考虑到了个体差异，如遗传因素，因此即使是最合适的药物也可能因个体差异而失效。指南的存在使得医生在面对治疗失败时有明确的后续步骤。

🎯指南的使用可以提高治疗的效率和质量。一个拥有详细指南的精神科医生，能够比仅知道某种药物是最佳选择的医生提供更好的医疗服务。

🤕指南的缺失在其他领域是一个问题。作者表达了对其他关心领域缺乏类似医学指南的失望，这些指南在其他行业中同样具有潜在的价值。

Medicine loves guidelines. But everywhere else, guidelines are still underappreciated.

Consider a recommendation, like “Try Lexapro!” Even if Lexapro is a good medication, it might not be a good medication for your situation. And even if it’s a good medication for your situation, it might fail for unpredictable reasons involving genetics and individual variability.

So medicine uses guidelines – algorithms that eventually result in a recommendation. A typical guideline for treating depression might look like this (this is a very over-simplified version for an example only, NOT MEDICAL ADVICE):

1. Ask the patient if they have symptoms of bipolar disorder. If so, ignore everything else on here and move to the bipolar guideline.

2. If the depression seems more anxious, try Lexapro. Or if the depression seems more anergic, try Wellbutrin.

3. Wait one month. If it works perfectly, declare victory. If it works a little but not enough, increase the dose. If it doesn’t work at all, stop it and move on to the next step.

4. Try Zoloft, Remeron, or Effexor. Repeat Step 3.

5. Cycle through steps 3 and 4 until you either find something that works, or you and your patient agree that you don’t have enough time and patience to continue cycling through this tier of options and you want to try another tier with more risks in exchange for more potential benefits.

6. If the depression seems more melancholic, try Anafranil. Or if the depression seems more atypical, try Nardil. Or if your patient is on an earlier-tier medication that almost but not quite works, try augmenting with Abilify. Repeat Step 3.

7. Try electroconvulsive therapy.

The end result might be the recommendation “try Lexapro!”, but you know where to go if that doesn’t work. A psychiatrist armed with this guideline can do much better work than one who just happens to know that Lexapro is the best antidepressant, even if Lexapro really is the best antidepressant. Whenever I’m hopelessly confused about what to do with a difficult patient, I find it really reassuring that I can go back to a guideline like this, put together by top psychiatrists working off the best evidence available.

This makes it even more infuriating that there’s nothing like this for other areas I care about.