[Guidelines in surgery: from the viewpoint of clinical research]

The concept of clinical practice guidelines is full of sociological conditions which cannot be transferred from one country to another without local tailoring. The quality of health care emphasizes both individuals and groups, defines the probability of desired health outcomes, and requires concordance with contemporary professional knowledge. In this context, the experience-based, intuitive judgement of experts is heavily underestimated in the Angloamerican literature. Clinical guidelines are systematically developed statements which assist doctors and patients in finding appropriate health care. They are not dictatory in nature. In Germany, a three-phase model is preferred: check lists immediately, consensus-processes for intermediate time periods, and finally consensus with best-evidence synthesis.