Practice guidelines: which ones to follow?

Abstract

Three levels of recommendations have been amalgamated under the "practice guidelines" label: consensus papers of large groups such as the Bethesda Conference(1), guidelines and criteria prepared by groups or individuals based on opinions about and interpretation of the literature, and algorithms developed by managed care organizations. If these various documents were religious worshippers, they would not only sit in different churches, but would worship a different Supreme Being. However, the two authors have used the terms interchangeably, resulting in a quagmire in which physicians and their patients can only sink and attorneys and insurers can flourish.