Difficulties of implementing clinical guidelines in medical practice

Editor's note Clinical practice guidelines are systematic statements designed to assist doctors in diagnostic and therapeutic decisions, and have a long tradition in clinical medicine. They have been developed by physicians as a means of improving the quality of care and objective medical decision making, as well as of optimizing the use of resources [1] and thus possibly decreasing healthcare expenditure. Physicians are responsible for offering patients the best available treatment, but their often overloaded schedules can make it difficult for them to keep abreast of the latest medical advances in a rapidly evolving therapeutic field. The main aim of clinical guidelines is therefore that of aiding clinical decision making on the part of doctors who cannot integrate all of the published data concerning new technologies and knowledge in their everyday practice. However, although guidelines may be important in promoting quality, they can also be harmful if they do not really advocate the best options for patients because of scientific uncertainties, biases in guideline development and/or patient heterogeneity [2]. This was particularly true some years ago (when many guidelines were consensus‐based rather than being explicitly linked to proof of effectiveness), but a greater effort has more recently been made to develop recommendations based as much as possible on clear‐cut data published in the medical literature.