on is that such inconsistencies reflect either under utilization or over utilization of resources in certain areas. The inconsistencies, within the context of this assumption, provide support for a contention that widespread use of clinical guidelines may reduce practice variation by guiding physicians who are uncertain about the indications for specific procedures, as well as the legal implications of their decisions.
Self-defense is one explanation for the move to develop practice guidelines. A prevailing assumption that physicians cannot be trusted either (1) to know what treatment is best in a given situation or (2) to make an ethical decision regardless of knowledge level leads to a situation wherein the larger socioeconomic system provides guidelines that constrain a physician's ability to determine care practices. Traditional resistance by physicians has referred to such constraints as "cookbook medicine." In the contemporary period, however, some physicians are participating in the creation practice guidelines "as a means of
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