Assessing the quality of clinical practice guidelines

Clinical guidelines have a more fundamental flaw than those discussed recently in CMAJ.1^,2 This flaw was expressed by the pioneer Harvard endocrinologist Fuller Albright. In his introduction to a textbook of medicine popular many years ago, he wrote that medicine can be practised by the rules (read guidelines) and they may help 90% of the time but the other 10% the rules will do more harm than they do good in the 90%.

Guidelines are helpful to those who have knowledge but are dangerous in the hands of those who do not, a group to whom guidelines may give confidence to exceed their knowledge. A physician without knowledge but with guidelines is like a monkey in a tree with a machine gun.