The Guidelines Challenge

This chapter looks at one of the key problems experienced by practitioners of medicine today, especially in large or public institutions, which is how to handle guidelines. Public management approaches to medicine tend to promote guidelines as rules to follow, and clinicians often feel pressure to follow a guideline even when their judgment cautions them to do otherwise. This ‘tramline’ approach to guidelines, we show, is philosophically as well as practically problematic. Especially when we take dispositions as the ontology of the causal relations that guidelines want to key in on—the best way to cause a recovery, or to counteract the causes of a condition—we see that guidelines cannot and ought not be treated as rules to be followed. We thus also make suggestions in this chapter about what kinds of guidelines, in terms of form and function, might be ideal.