Credibility, Cookbook Medicine, and Common Sense: Guidelines and the College

Guideline [n] −a line by which one is guided: a.) a cord or rope to aid a passer over a difficult point or to permit retracing a course; b.) an indication or outline (as by a government) of policy or conduct [1].

Practice guidelines − systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances [2].

Guidelines and their siblings (protocols and algorithms) are not new [3]. However, their popularity has burgeoned, especially when compared with their more restrictive first cousins (standards, prediction rules, and decision rules) (Table 1). They have been hailed as the salvation from the wide variations in medical care and simultaneously lamented as harbingers of the ruination of medicine as we know it [4]. A friend expressed concern about the potential for lawsuits now that his subspecialty organization is developing guidelines. In Maine, steps have been taken to protect guideline users against liability [5]. One wonders how such a seemingly harmless term became invested with such great and terrible expectations!

In this issue, Tunis and colleagues [6] discuss how American College of Physicians (ACP) members view guidelines whose development the College has fostered through the Clinical Efficacy Assessment Project [7-9]. The disconcerting finding that 7% of respondents indicated familiarity with fictitious guidelines must be considered when assessing the 11% to 59% who reported familiarity with actual guidelines. Although the lack of familiarity with the guidelines recently issued by the federal Agency for Health Care Policy and Research, which was authorized to promote guideline development and dissemination [3], is understandable, the 11% figure was for ACP …