title: Legal and policy considerations in using clinical practice guidelines.
abstract: The increased use of clinical practice guidelines has implications for both public policy and for litigation. Physicians are concerned that the introduction of practice guidelines will reduce their clinical decision-making authority and that the failure to follow clinical practice guidelines will lead to medical liability. Although practice guidelines are an increasing part of medical practice, there has been only limited litigation to determine the extent to which guidelines will be used to set the applicable standard of care. This article discusses the potential legal and public policy issues raised by the introduction and use of clinical practice guidelines. From a legal perspective, the primary issue is whether guidelines will be used to set the "standard of care" or will be one piece of evidence that a jury would use to determine the outcome of medical liability litigation. Based on an assessment of the applicable legal and policy considerations, the article concludes that courts should admit guidelines into evidence, but that they should not be used as the sole determinant of the standard of care. Instead, guidelines should be treated as one piece of evidence to be weighed by the jury. This approach will facilitate physician acceptance of guidelines by not imposing liability for the failure to follow guidelines without additional evidence to determine the standard of care.
authors.affiliation: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Jacobson
mesh_terms: D015510:Clinical Medicine / Q000331:legislation & jurisprudence* / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D007603:Jurisprudence; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D014481:United States; D014600:Utilization Review