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Rob Mullen posted: > ...I also think that somehow penalizing physicians for lack of adherence to published guidelines in the context of treating a particular patient would be a significant misuse of guidelines in the name of quality measurement. This could have the unintended(?) effect of paralyzing innovation and turning all clinicians into technicians, rather than problem-solvers. On the other hand, the application of quality measurement to practice patterns does seem to have some potential value... > A similar point was discussed several years ago in an interdiscipinary international special interest group on healthcare quality that I facilitated. Some expressed an opinion that deviation from published guidelines constituted medical error. Discussion moved that opinion to agreement that deviation per se is not the problem; rather, failure to document a reason in the clinical record for deviating from standard protocols or accepted guidelines is the real problem. Reliable communication and documentation of decisions may be an important action toward preventing inappropriate efforts to constrain clinical judgment. David. -- David Birnbaum, PhD, MPH Adjunct Professor School of Nursing & School of Population and Public Health University of British Columbia Principal, Applied Epidemiology British Columbia, Canada