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Practice Guidelines

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


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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