Guidelines in medical practice: the legal issues.

The use of guidelines represents a new culture in medicine-a shift of emphasis away from reliance on individual discretion towards greater professionalism and accountability. Although they are important vehicles for those who wish to evaluate and monitor healthcare practice against recognized standards, this paper explores the legal problems surrounding the implementation of guidelines in the National Health Service in the UK. The topic is considered from the clinician's perspective, but there are also lessons to be learned by managers. There is discussion of the difficulty in defining and prioritizing the numerous guidelines, and advice is given as to which guidance is the most authoritative. The legal consequences of ignoring guidelines are explored, and the paper concludes with the view that the time is ripe for clinicians to take the initiative in preparing, drafting, and disseminating guidelines before they are pre-empted by managers and employers and the future of clinical freedom is called into question.