Guiberteau Milton J, Wilcox Pamela A, Bjork Sandra
St. Joseph Radiology Associates, Houston, Texas 77227-7705, USA.
J Am Coll Radiol. 2004 Feb;1(2):92-7. doi: 10.1016/j.jacr.2003.11.013.
Clinical practice guidelines have emerged as a reality for medical practitioners over the past 20 years. Although virtually all groups interested in the development of practice guidelines hope for improvements in patient care, secondary expectations vary widely among those using them. Their use in daily practice by physicians has met with resistance from barriers including concerns of "cookbook" medicine, a loss of autonomy, and increased professional liability. The recent experience of the ACR in addressing these challenges illustrates that physicians are receptive to steps perceived to mitigate the risks accompanying the use of guidelines as well as to efforts to increase their understanding of implementing guidelines in clinical practice. The experiences of other medical societies and an inventory of future trends reveal additional challenges associated with the use of practice guidelines, as third parties look to guidelines as points of reference for gauging the performance of health care providers.
在过去20年里，临床实践指南已成为执业医师面临的现实情况。尽管几乎所有对制定实践指南感兴趣的团体都希望改善患者护理，但使用指南的各方的次要期望差异很大。医师在日常实践中使用指南时遇到了阻力，这些阻力包括对“菜谱式”医学的担忧、自主权的丧失以及职业责任的增加。美国风湿病学会（ACR）近期应对这些挑战的经验表明，医师愿意接受那些被认为能降低使用指南所带来风险的措施，以及为增强他们对在临床实践中实施指南的理解所做的努力。其他医学协会的经验以及对未来趋势的梳理揭示了与使用实践指南相关的更多挑战，因为第三方将指南视为衡量医疗服务提供者绩效的参考依据。
