title: Democracy-based consensus in medicine.
abstract: BACKGROUND
  High-quality evidence and derived guidelines, as typically published in major academic journals, are a major process that shapes physician decision-making worldwide. However, for many aspects of medical practice, there is a lack of High-quality evidence or an overload of somewhat contradictory low-quality information, which makes decision-making a difficult, uncertain, and unpredictable process. When the issues in question are important and evidence limited or controversial, the medical community seeks to establish common ground for "best practice" through consensus conferences and consensus statements or guidelines. Such consensus statements are seen as a useful tool to establish expert agreement, define the boundaries of acceptable practice, provide priorities for the research agenda, and obtain opinions from different countries and healthcare systems. This standard approach, however, can be criticized for being elitist, noninclusive, and poorly representative of the community of clinicians who will have to make decisions about the implementation of such recommendations.
  
  
  OBJECTIVE
  Accordingly, the authors propose a new model based on a combination of a local core meeting (detailed review and expert input) followed by a worldwide web-based network assessment (democracy-based consensus). The authors already have applied this approach to develop consensus on all nonsurgical interventions that increase or reduce perioperative mortality in critically ill patients and in those with acute kidney injury.
  
  
  METHODS
  The methodology was based on 5 sequential local and web-based steps.
  
  
  RESULTS
  Both a panel of experts and a large number of professionals from all over the world were involved, giving birth to a new type of "democracy-based consensus."
  
  
  CONCLUSIONS
  This new type of "democracy-based consensus" has the potential to increase grass-root clinician involvement, expand the reach to less-developed countries, provide a more global perspective on proposed interventions, and perhaps more importantly, increase awareness, ownership, and the statistical likelihood of subsequent implementation.
authors: Department of Anesthesia and Intensive Care, IRRCS San Raffaele Scientific Institute, Milan, Italy.
authors: Massimiliano
authors: M
authors: Greco
authors: Department of Anesthesia and Intensive Care, IRRCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
authors: Alberto
authors: A
authors: Zangrillo
authors: Department of Anesthesia and Intensive Care, IRRCS San Raffaele Scientific Institute, Milan, Italy.
authors: Marta
authors: M
authors: Mucchetti
authors: Department of Anesthesia and Intensive Care, IRRCS San Raffaele Scientific Institute, Milan, Italy.
authors: Leda
authors: L
authors: Nobile
authors: Department of Management, Economics and Industrial Engineering, Politecnico di Milano Via Lambruschini, Milano, Italy.
authors: Paolo
authors: P
authors: Landoni
authors: Department of Intensive Care Australian and New Zealand Intensive Care Research Centre Melbourne, Australia.
authors: Rinaldo
authors: R
authors: Bellomo
authors: Department of Anesthesia and Intensive Care, IRRCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it.
authors: Giovanni
authors: G
authors: Landoni
mesh_terms: D032921:Consensus; D003657:Decision Making; D003709:Democracy; D006801:Humans; D010820:Physicians / Q000639:trends
keywords: consensus conference; democracy-based medicine; knowledge sharing; web-based network