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Commentary: When Is a Practice Guideline Only a Guideline?

Dr. Zonana is Professor of Psychiatry, Yale University School of Medicine, Clinical Professor (Adjunct) of Law, Yale Law School, New Haven, CT, and Medical Director, AAPL. Address correspondence to: Howard Zonana, MD, Department of Psychiatry, Yale University School of Medicine, CMHC, 34 Park Street, Room 153, New Haven, CT 06519-1187. E-mail: howard.zonana{at}yale.edu

Clinical Practice Guidelines (CPGs) have been promulgated by a variety of sources with differing goals: professional societies, state and federal governmental bodies, third-party payers such as insurers and HMOs, and hospitals. Compliance rates by practitioners are modest at best so that their use as standards of care for "usual and customary" practice is questionable. Some states are experimenting with the use of CPGs as a requirement for malpractice coverage.