Practice Guidelines:
1.    Guidelines prevail in the decision making process.  Law consistently refuses to accept guidelines of rebuttal evidence as to what is appropriate.  Only way to determine for certain, is to have an expert witness testify.
2.    Initially created for quality-assurance reasons.
a)    Needed some sort of principles to guide them in determining if there was a violation of the standard of care.  Means of peer review.
3.    Acceptance of guidelines by medical staff, physicians looked to whether they should be writing guidelines.
4.    The concept is evidence-based treatment.  The guidelines are based on evidence and so they are really standard-based literature.
5.    Have been created by medical associations on the management of certain injuries.
a)    Careful to suggest they are only guidelines and not standards.  If standards, the process would be heavily scrutinized.
6.    Created by the government–the Agency for Healthcare Policy and Research was created to determine whether Medicare ought to pay for services.
a)    Government has created the guidelines by agencies for specific reasons – medicare, for example.  Guidelines have also been created by the legislature involving insurance payment, etc.

7.    Liability Concern:  Not accepted as the standard of care.  But there have been sanctions for not treating patients the way the guidelines suggest.
8.    Generally written for well-understood diseases.
9.    More likely to be espoused by non-surgeons, than surgeons.  To some extent they are accepted by the government but they are not legally binding.
a)    They can be used to support what the standard of care is, but they must be supported by expert testimony.
10.    Medical evidence–based treatment protocols: the buzzword now for guidelines
a)    Kind of like Restatements.
b)    Sort of like an algorithm or a recipe.
c)    Most are written by professional associations.