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To the Editor: In addition to the issues regarding clinical practice guidelines raised in the Editorial by Drs Shaneyfelt and Centor,¹ another unintended consequence of the use of guidelines is the potential adverse effect on medical education. It may be standard rhetoric to state that guidelines are just guides, and physicians must use their discretion in clinical decision making. However, bombarding students with guidelines for all scenarios in seminars, textbooks, and journals is like providing them with the printout of the destination without showing the road map. It may seem more efficient in the short-term but does little to enhance discriminatory skills and numbs the facility for critical thinking.

Financial Disclosures: None reported.

Shyam S. Kothari, MD
kothariss@vsnl.com
Department of Cardiology
All India Institute Medical Sciences
New Delhi, India

1. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. JAMA. 2009;301(8):868-869. FREE FULL TEXT

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2009;302(2):145.

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