Viewpoints in This Issue of JAMA


How to Decide Whether a Clinical Practice Guideline Is Trustworthy

David F. Ransohoff, M.D., of the University of North Carolina School of Medicine, Chapel Hill, and colleagues discuss concerns about the process of developing clinical practice guidelines and the standards for developing practice guidelines created by the Institute of Medicine (IOM).

“Guidelines, especially those that try to set limits, will always raise controversy. Clinicians, patients, and policy makers should insist upon a constructive dialog about the evidence and its translation into recommendations. An explicit, transparent process for evaluating adherence to the IOM committee’s standards should elevate this conversation to a higher plane.”

(JAMA. 2013;309[2]:139-140. Available pre-embargo to the media at


Changing Physical Activity Participation for the Medical Profession

Antronette K. Yancey, M.D., M.P.H., of the UCLA Fielding School of Public Health, Los Angeles, and colleagues offer suggestions on how health professionals can improve and incorporate physical activity into their lifestyle.

“Simple and quick episodes of moderate to vigorous physical activity can be incorporated into the workplace without disrupting workflow or productivity. Given the value of regular physical activity to health, the medical profession should lead the way in adopting such practices.”

(JAMA. 2013;309[2]:141-142. Available pre-embargo to the media at


Physical Activity and Structured Exercise for Patients With Stable Ischemic Heart Disease

William E. Boden, M.D., of the Samuel Stratton VA Medical Center and Albany Medical College, Albany, New York, and colleagues examine the gap between scientific evidence and clinical practice regarding structured exercise and increased physical activity for patients with stable ischemic heart disease.

“In an era of spiraling health care expenditures, structured exercise regimens, increased physical activity, or both may be the ultimate low-cost therapy for achieving improved health outcomes. If the ‘exercise is medicine’ adage is to be applied and optimized, the prescription at present remains underfilled for too many patients with stable ischemic heart disease. Thus, the medical community should embrace this clinically effective and cost-effective strategy as a first-line therapy, thereby enabling patients to realize the health benefits from a lifestyle intervention that must become more mainstream in U.S. medical practice.”

(JAMA. 2013;309[2]:143-144. Available pre-embargo to the media at


Appropriate Use of Non-English-Language Skills in Clinical Care

“An estimated 25 million U.S. residents have limited English proficiency (LEP) and in a 2006 national survey of 2,022 internists, 54 percent reported encountering patients with LEP at least weekly, with many seeing LEP patients every day,” writes Marsha Regenstein, Ph.D., M.C.P., of the George Washington University School of Public Health and Health Services, Washington, D.C., and colleagues. In this Viewpoint, the authors examine the issue of the use of non-English-language skills in clinical care, including clinical encounters potentially needing language interpreters.

“Clinicians should also consider ways to detect when a non-English-language encounter is becoming more likely to cause communication errors. In particular, using teach-back, a National Quality Forum-endorsed practice in which clinicians explicitly state key points of instruction and ask patients to restate them to ensure clarity, is useful in many settings. This can be an especially important means for ongoing communication quality assurance for physicians using their non-English language skills in clinical practice.”

(JAMA. 2013;309[2]:145-146. Available pre-embargo to the media at

Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

 # # #