Conflicting information: some thoughts

Last updated: Sunday, September 25, 2022

Know the limitations of your resources 

It is important to understand the limitations of different resources so that when faced with conflicting information you can decide which course of action to follow. For example, there may be important differences in information about doses and indications between UK and US sources because of variations in marketing authorisations or accepted practice.

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Information about using medicines in patients with co-morbidities in SmPCs may be quite cautious when compared to sources based partly on expert opinion such as the Maudsley Guidelines and the Psychotropic Drug Directory. The SmPC has to reflect the experience that the manufacturer has been able to gain with the medicine in clinical trials. For example, an SmPC will almost always advise against the use of a medicine in pregnancy, but specialist resources may be better able guide your decision-making by drawing on other sources of information.

Sometimes official guidance such as that from the UK Health Security Agency or the MHRA may differ (and even override) information in SmPCs and the BNF.

Breaking news 

Faced with conflicting information, think about whether new evidence or guidance may have been published which may explain the differences you find. Most books are probably a couple of years out-of-date when they are published – could this account for some different advice you've encountered? Even online resources can be updated fairly haphazardly – for example SmPCs don’t always incorporate new MHRA safety warnings immediately, and sometimes there can be a significant delay – could this explain your findings?

Getting to the bottom of things 

If they are available, consult the reference lists of the publications you have used – do the resources vary in the evidence upon which they have based their conclusions? Could this account for the conflicting advice? Even using the same evidence, different experts may come to different conclusions. If necessary track down the original papers and make your own decision with your patient in mind.

Reaching the consensus

Is one of your resources at odds with everything else you are finding? Remember that the answer you provide should usually represent the consensus of opinion, and you will need to keep checking different resources until you get a feel for what the majority recommend.

Making the decision

Having worked through all of the steps above you hopefully will have worked out why your resources are giving you different messages and you’ve been able to make a decision about your individual patient. In discussing your findings with the consultant, and ideally the patient as well, you may need to highlight the differences you’ve encountered and justify your recommendations. As always, don't be afraid to ask for help if you need it, and you should consider documenting your decision and the reason(s) for it.