ABSTRACT
Clinical guidelines can have an important role to play in situations where there is both considerable certainty about the best approach to treatment and where significant departure from such practice has no valid justification. Uncritical adherence to clinical guidelines may lead to inappropriate clinical care. Autonomous clinical thought is undermined by unthinking conformity to clinical guidelines. Despite pressure from purchasers, rigaid adherence to guidelines cannot be formal managerial or legal expactation in the National Health Service (NHS). Selection, estimation and classification play their part in clinical judgment which should not be viewed as a unitary process. The harsh effects of restraining medical costs, mediated by payer-influenced clinical guidelines threaten clinical freedom in the UK. UK common law has preserved an aspect of professionally defined and professionally countenanced clinical freedom in the test it continues to adopt in deciding upon actions alleging medical negligence.
