The evolution of guidelines toward standards of practice.

The development of practice guidelines and its many synonyms has been the source of concern and a large amount of work in surgical specialty practice, especially over the last decade. These guidelines represent improvements and refinements. If they are strongly adhered to, standards of practice without consideration of outliers, physician judgment, and the man on the scene, then they have the capacity for great misunderstanding and harm. In general, I firmly believe that surgeons, their hospitals, and everybody involved in the process will find the preparation for transparency a positive experience, and that these guidelines, when properly assessed and refined by practicing surgical specialists, can become a strong asset not only for ourselves and our profession but also for our patients. In the future, guidelines must be carefully stated with specific exceptions and caveats. These guidelines need the respect, the careful judgment of the physician at the time and place, and the relative roles of a consultation and even second opinions. We must also be aware of the substantial capacity for influence of these standards by industry. A careful and ongoing analysis of the self-serving aspects of such work is essential. However, these observations and our work make the decision for elective surgical operations safer than it has ever been.