Various factors, including increased financial pressures on the health system, the rapidity of the introduction of technology, and data showing high levels of inappropriate care, will coalesce into a movement that will yield practice guidelines. If the guidelines are developed with the aid of the best methods and if they are applied constructively, then the twin goals of increased health of the American public and physician satisfaction can be achieved. (JAMA. 1989;262:3027-3030)