ABSTRACT
Codes, regulations and recommendations as to how doctors should practice are almost as old as the profession, but for most of history, they have been little more than ex cathedra pronouncements from influential individuals, or at best a summary of the experience of the good and the great.1 Early examples of national guidelines included the American Academy of Paediatrics (treatment of infectious diseases, 1938) and the American College of Obstetricians and Gynaecologists (practice standards, 1959). Only recently have we moved on from such consensus to systematic guidelines as concise summaries of ‘best evidence’ for a specific clinical condition that can support clinical decisions. Healthcare organisations across the world, whether publicly or privately funded, have to grapple with common problems such as: • Delays of up to 10 years between publication of good research and its
clinical application. • Costs rising faster than inflation, and the need for probity in the use of
public funds. • Variation in clinical practice: clinicians manage the same problem in many
ways. Not all variation is bad: it may represent lack of evidence about the best methods, or sensible adaptation to local factors, but some represents sub-standard care.
