The impact of clinical guidelines and clinical pathways on medical practice: effectiveness and medico-legal aspects.

The 1990s will be remembered as a decade when quality assurance, evidence-based medicine and clinical quality improvement became key issues in the delivery of health care in hospitals and community settings. As public expectations of high quality health care increase in the face of diminishing resources and as accountability and standardisation of clinical practice are demanded by both consumers and professional regulatory bodies, the medical profession has responded with a proliferation of clinical practice guidelines and pathways. The efforts have been spearheaded by the various professional and academic colleges. Despite all the enthusiasm that has been created, there is still uncertainty regarding the clinical effectiveness, validity and medico-legal effects of practice guidelines and clinical pathways. This article focuses on the reasons behind the increasing popularity of clinical guidelines and pathways, a critical appraisal of their effectiveness and the medico-legal implications, effects and consequences of implementing such guidelines in clinical practice.