[Guidelines as shared auxiliary policies].

Abstract

Practice guidelines can be thought as a "dynamic technology", whose characteristics vary according to the specific context of application, the type of social relationships they assume, their implicit or explicit goals. In this light, guidelines can be seen as an operational interpretation of the relationships among social components both within and outside the medical profession. The currently dominant models in terms of development of recommendations for clinical practice, using guidelines respectively as assistance to and administrative control over clinical decision making, seem to be both inadequate because of the social models they implicitly assume: the medical-technical dominance and an external political control over the medical profession, respectively. These models fall short in dealing with the complexity of the health care issues we are facing. As an alternative, the notion of guidelines as development of shared clinical policies is put forward. Development of shared clinical policies relies on: a) use of available empirical evidence, whose qualitative and quantitative limitations are fully acknowledged, as the frame of reference for an open conformation among the different stakeholders; b) the acknowledgement that conflicts among different views and vested interests are an organic component of health care.