•Guidelines should never be used as a basis for disciplinary action or litigation if the physician or surgeon
determines that strict adherence to their provisions is
not in the patient’s best interest.
Patients should have the freedom to choose their
own physician and engage in shared decision making
regarding their care. Patients should be encouraged to
choose care that meets the following criteria:
•Supported by evidence
•Doesn’t duplicate tests or procedures already
• Truly necessary
Physicians and surgeons should be involved in the
creation, approval, implementation, review, and
modification of all guidelines that affect medical care.
Physician leaders at hospitals, physician organizations,
and individual practitioners should be diligent in the
responsible creation, evaluation, and subsequent implementation of guidelines.
Undesirable or unproven guidelines or portions
thereof must be rejected and the objections appropriately documented.
Guidelines that are formulated and maintained
through this rigorous process should be followed
within reason and in good faith, with the patient’s
best interest always at the forefront. Exceptional cir-
cumstances and variations in patient condition or
circumstances should be anticipated and documented.
Patterns of exceptions should lead to refinement of
Guidelines for specific disease processes developed
by governmental agencies or mandated by legislation should follow nationally accepted evidence-based
standards of care, have input from physicians, and
always put the safety of the patient first.
Appropriate roles for government are the
•Reaffirm the physician’s responsibility for patient care
•Ensure patients have access to health care
•Provide for shared decision making between a patient
The ACS believes that the patient has a right to
choose a physician and that the physician has a right
to freely direct, without interference, the care of the
patient. Guidelines may be used to assist the phy-
sician, surgeon, and other health care providers in
achieving this goal, but should not impede the pro-
cess or deviate from this purpose. ♦
Physicians and surgeons should be involved in the creation,
approval, implementation, review, and modification
of all guidelines that affect medical care.