In medicine, guidelines are essential. They provide a framework for diagnosis, treatment, and patient care. They are built on evidence, research, and years of clinical experience. Yet, as valuable as guidelines are, they cannot replace judgment. Every patient is unique, every disease can present differently, and every situation carries variables that cannot always be captured in a standardized approach. Learning when to rely on guidelines and when to trust judgment is one of the most important lessons in clinical practice and one that has shaped my leadership in biotech and clinical development.
The Role of Guidelines in Medicine
Guidelines serve an essential function. They synthesize large amounts of data, provide evidence-based recommendations, and ensure consistency in care. For a clinician, they are a starting point. They help prevent errors, standardize approaches, and offer support when faced with common or well-understood conditions.
During my training in hematology and internal medicine, I relied on guidelines frequently. They gave me confidence when making routine decisions and provided a reference when I encountered unfamiliar conditions. They are an indispensable tool, especially for early-career clinicians or in high-volume practice settings.
When Checklists Are Not Enough
However, medicine is rarely simple. Patients do not always fit neatly into guideline boxes. Comorbidities, atypical presentations, rare diseases, and individual preferences often require thinking beyond the standard approach. In these situations, strict adherence to checklists can limit flexibility and even compromise patient care.
I have cared for patients whose situations required deviation from protocol. These were not arbitrary choices. They were grounded in careful assessment, understanding of physiology, clinical experience, and ethical consideration. Guidelines informed my decisions, but judgment guided them. Recognizing when to move from following rules to applying judgment is a skill cultivated over years of practice.
The Intersection of Leadership and Clinical Judgment
The same principle applies to leadership in clinical development and biotech. Guidelines and standard operating procedures provide structure. They ensure compliance, safety, and consistency across teams and projects. Yet, leaders frequently encounter situations that fall outside these predefined rules.
Effective leadership requires judgment. It involves assessing incomplete information, anticipating consequences, balancing competing priorities, and making decisions under uncertainty. Just as a physician must adjust treatment based on the patient in front of them, a leader must adjust strategy based on the team, the project, and the broader environment. This is where experience, critical thinking, and empathy come together to inform action.
Developing Judgment Through Experience
Judgment cannot be taught entirely through textbooks or checklists. It develops through experience, reflection, and mentorship. In medicine, exposure to a wide range of cases and patient scenarios builds intuition about what works, what is safe, and when adaptation is required.
In leadership, the same applies. Experiencing complex project decisions, navigating regulatory challenges, and managing teams under pressure helps cultivate judgment. Mistakes and setbacks, when analyzed thoughtfully, become powerful lessons that sharpen decision-making skills. Mentorship is also critical, providing guidance and perspective to help refine judgment in situations that cannot be reduced to a simple guideline.
Balancing Protocols and Individualized Decisions
One of the greatest challenges is finding the right balance between following guidelines and exercising judgment. Too rigid an adherence can stifle innovation, reduce responsiveness, and fail to account for real-world variability. Too much reliance on judgment alone can introduce inconsistency, increase risk, and undermine confidence in the process.
In clinical trials, this balance is particularly important. Protocols provide the backbone of scientific rigor, but patient safety, trial feasibility, and unexpected outcomes often require adaptation. Leaders who understand the principles behind guidelines can adjust approaches without compromising integrity. They apply judgment while respecting the intent of the framework, ensuring both safety and progress.
Mentoring the Next Generation
Part of my work in leadership and as a Graduate Teaching Assistant involves helping others develop the same balance. Early-career scientists and clinicians often focus heavily on following rules or protocols precisely. While this is necessary for foundational understanding, it is equally important to teach when to step beyond them thoughtfully and responsibly.
Encouraging mentees to analyze situations critically, ask questions, and consider context cultivates judgment. This prepares them to navigate complex decisions in medicine and leadership with confidence and ethical integrity. Guideline literacy and judgment are not opposing skills. They complement each other when applied intelligently.
A Personal Reflection
Medicine has taught me that guidelines are tools, not absolutes. They provide clarity and structure but cannot replace the nuanced understanding that comes from experience, empathy, and critical thinking. Leadership requires the same mindset. Whether guiding a team, making strategic decisions, or designing a clinical development program, judgment is essential when rules and procedures do not cover every scenario.
The ability to balance structure with flexibility is one of the most valuable skills a physician or leader can develop. It allows us to deliver patient-centered care, advance meaningful scientific work, and lead teams effectively. Ultimately, guidelines inform our decisions, but judgment ensures those decisions serve people, patients, and communities in the most thoughtful and responsible way possible.
When I reflect on my career, the most rewarding moments often come from decisions that required stepping beyond the checklist. Those are the moments where science, ethics, and leadership intersect, and where meaningful impact is achieved. It is in this space between guidelines and judgment that true leadership in medicine and science emerges.