Medical guidelines: a valid and reliable management tool?

Medical practice guidelines are one instrument to improve either quality care or to encourage efficient health care production. To achieve these goals they have to be valid, reliable, clinically applicable, clear, and timely revised. This article checks whether current efforts to develop and establish guidelines meet these criteria. Unfortunately, it turns out that especially the compliance of the first two criteria is problematic. It is concluded that medical guidelines are, as yet, neither a scientifically sound way to improve quality care nor a ready means to improve efficient care production. Approaches to complement these efforts are therefore discussed.