Context: The effort invested in clinical practice guidelines has rarely been repaid by their use by practitioners in any medical specialty. Practitioners resist the oversimplified intrusion on their clinical autonomy. They do not agree with the interpretation of inadequate, outdated evidence and they do not see applicability to their particular patients. Some see the recommendations are beyond them or their patients or that the cost or inconvenience outweighs benefit.
Issues: This will not be overcome by more and better guidelines nor by enforcement by policing through re-registration or CPD. [Policing risks annihilating the creative adaptation of practice to patient needs.] However patients and other consumers have uses for clinical practice guidelines that warrant their development.
Objective: This paper explores how guidelines might be produced with this use in mind, especially how the anarchic democracy of the Internet may be harnessed to the purpose.
Key messages: In the hands of patients, guidelines can promote dialogue, inform the critical review and justification of treatment and support the exploration of alternatives where treatment is not succeeding. Marketing clinical practice guidelines directly to clinicians must fail. Retailing guidelines through consumers may foster the maintenance and updating of practitioners’ clinical skills.
