Commentary: when is a practice guideline only a guideline?

Clinical Practice Guidelines (CPGs) have been promulgated by a variety of sources with differing goals: professional societies, state and federal governmental bodies, third-party payers such as insurers and HMOs, and hospitals. Compliance rates by practitioners are modest at best so that their use as standards of care for "usual and customary" practice is questionable. Some states are experimenting with the use of CPGs as a requirement for malpractice coverage.