Recipes or roadmaps? Instead of rejecting clinical practice guidelines as "cookbook" solutions, could physicians use them as roadmaps for the journey of patient care?

Clinical practice guidelines (CPGs) have become an inescapable part of the contemporary practice environment. Rooted in the desire to reduce unwanted practice variation, the CPG "movement" has been accelerated in recent years by the pressure to minimize the cost, while maintaining or even enhancing the quality, of health care. As a result, CPGs should now be indispensable to practitioners, particularly in an era when "evidence-based medicine" has been so widely embraced and so highly touted. Why, then, is there a continuing gulf between the generation and dissemination of CPGs and their translation into changes -- and presumably improvements -- in practice? Dr. David Davis and Ms. Anne Taylor-Vaisey (page 408), offer a lucid and comprehensive exposition of the multifactorial etiology of the failure of "naturalistic" CPG implementation, citing such barriers as CPG quality, patient and provider characteristics, practice setting, incentives and regulation. Looming large among these barriers are our attitudes as practitioners. To paraphrase US humorist Will Rogers, "We all approve of progress; it's change that we don't like." On a more optimistic note, Davis and Taylor-Vaisey observe that a change in attitude seems to be taking place, citing a growing receptiveness toward CPGs among the younger generation of Canadian practitioners. This openness probably reflects the growing emphasis given to information literacy and critical appraisal in today's undergraduate and postgraduate medical curricula. Still, rejection of CPGs as "cookbooks" that fail to take into account the art of medicine is common.