Practice Guidelines and Prediction Rules Should Be Subject to Careful Clinical Testing

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Abstract
Practice guidelines, prediction rules, and protocols are now everywhere. During the past decade, a number of guidelines and prediction rules have become available to assist clinicians and patients in the diagnosis and treatment of many different conditions. Whether clinical recommendations are expressed as clinical practice guidelines, prediction rules, or protocols the intent is clear: to inform medical decisions and to decrease variations in care by systematically influencing clinical decisions. Specifically, the goal is to change the way we care for patients. In the past, there have been few intrusions in the privacy of the physician-patient relationship, and some clinicians are bcoming concerned that prediction rules and guidelines will devalue the "art of medicine" and threaten clinical autonomy. See also p 1935. Other clinicians may dismiss guidelines and prediction rules as another fad in health care management that will be replaced by the next up-and-coming fad. In support of their argument