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June 13, 1990

Practice Guidelines

Author Affiliations

Quality Standards in Medicine, Inc Bethesda, Md

Quality Standards in Medicine, Inc Bethesda, Md

JAMA. 1990;263(22):3021-3022. doi:10.1001/jama.1990.03440220043016

To the Editor.—  In his article on practice guidelines, Dr Brook1 explains well the need for and the various forces driving toward practice guidelines and their value if developed and used appropriately. However, he fails to explore adequately their competing purposes and objectives and how these considerations might influence their content and use. Of particular concern are his emphasis on "one set fits all" and his desire for a single purveyor of the truth.Practice guidelines encompass many uses, for example, prospectively assisting a physician to select the most appropriate diagnostic and therapeutic interventions and retrospectively assessing a physician's quality of care. Until complete guidelines can be developed, depending on their purpose, they will differ. Practice guidelines are shaped by the extent to which costs are equated with benefits. Usually, practice guidelines are conceived in the context of a given health problem and any trade-offs among costs and