What is to become of the College clinical practice guidelines?

Objective: College guidelines have been published "to assist practitioner and patient decisions" in treatment. There is little evidence that the guidelines have been used despite their apparent importance in the maintenance of treatment that is adequate, competent, safe, honest and up-to-date. This paper discusses the value and non-use of College clinical practice guidelines and examines possible ways that they may be promulgated and used. Conclusions: Guideline research indicates that clinicians will ignore guidelines for reasons that include impracticality, inflexibility, oversimplification and disagreements with evidence interpretation. Their objections cannot be solved by guideline writers. Consumers have a legitimate use for guidelines and this can become the starting point for informed discussion of treatment and necessary deviations from standardized care. Through consumers, the guidelines can make their way into practitioners' awareness and play a role in the maintenance of treatment quality.