When does a guideline become a standard? The new American Society of Anesthesiologists guidelines give us a clue.

So when does a guideline become a standard? The answer is when an inexpensive, reliable device comes onto the market, the technology and concept of which have already been adopted by a group who specialize in the concept of intubation--anesthesiologists. A guideline becomes a standard of care when the device behind the guideline is available and readily usable as a practical matter by members of other medical specialties who have cause and reason to consider its use. By the time a piece of technology is recognized by legislators or insurance company underwriting departments as a necessary tool in the arsenal of a group of medical professionals, essentially as a standard of care, it is too late in the sense that the damage will already have been done because the malpractice suits that motivated the legislative or underwriting change already will be inescapably present. The mandation of a standard of care by legislative or insurance underwriting fiat certainly ensures the existence of the standard and will serve to require the use of the procedures, techniques, or technology so mandated. Before the mandation by law, however, the profession must recognize the matriculation of the idea to the guideline to the standard. Waiting for adoption of the standard by law or insurance company underwriting departments gives the plaintiff's trial bar "an edge," in that they are able to assert that a standard exists that the physicians are ignoring.(ABSTRACT TRUNCATED AT 250 WORDS)