Guidelines for every person

Guidelines, it is assumed in health care circles, have worth. In the ideal health care system they may offer everything from medical certainty to legal protection. They have the potential to save practitioners from the trauma of indecision and at the same time protect them from the consequences of wrong decisions. In this paper, I discuss the impact of guidelines on general practitioners and consumers. Both groups are at the effector end where guidelines should have maximal impact. It is primarily medical practitioners and their constituents in the long run that have to make guidelines work. Theoretical questions about the essential worth of guidelines for consumers and general practitioners are explored, as well as the more practical issues of utility of guidelines. My hypothesis is that guidelines may be conceptually worthwhile, but as yet are of unproven utility. This argument is traced through the literature surrounding the involvement of general practitioners and consumers in guideline development, implementation, review and relevance. From this information a new role for guidelines which is cogniscent of the needs and circumstances of the end users is postulated. Guidelines can become the basis for the principles of sound clinical practice which allow for the unique individual circumstances of clinical practice whilst also providing a consolidated basis for this practice.