ch being the relative persuasiveness of the opposing expert witnesses. The primary value of practice guidelines, of course, is not their use in litigation but their use in practice: the extent to which they effectively elevate the quality of care is the measure of success. But whether the work product of a consensus conference is used to improve care quality of the practitioner or as a measure of the adequacy of the defendant's care of a particular patient in a particular set of circumstances, the guidelines need to be both credible and usable. The new JAMA format appears to be an excellent model for use in planning a consensus conference since the key elements of credibility are elicited. "Usability" perhaps is more a function of organization and style: it is impaired if the published guidelines are either overly specific or hopelessly general. in either case, the worth of the guidelines is diminished for both medical practitioners and litigators be they plaintiff or defense attorneys. Ultimately, as Olson[2] wrote in JAMA, "Readers themselves must assess the quality and the validity of consensus statements as they do for all literature."
Objective of the Consensus Statement: Immediate and Longer Term
The objective of the consensus statement must be defined clearly. An example of a clear definition of objective was provided by Drs. Dalen and Hirsh[3] in the introduction of the Second American College of Chest Physicians Conference on Antithrombotic Therapy: "We hope that these recommendations will assist clinicians in providing safe and effective antithrombotic therapy to their patients." While clearly expressing the immediate objective, Dalen and Hirsh went on to underscore the important catalytic role of such a conference for the achievement of longer-term objectives: "We are certain that these recommendations will lead to further dialogue and stimulate further studies in this important area of therapeutics."[3] While this fu...