The deadline for writing this piece has crept up and surprised me this time. `You know it's due by Friday', says the ever cheerful voice of Mary from Wiley's on my answering machine. I grumble back but no one is listening. Usually I know what I want to say. Now my mind is suddenly blank. This is a minor emergency. I'll have to think of something. I need inspiration. I need guidance. Perhaps what I need are guidelines. After all there are guidelines for almost everything these days. And I guess that one purpose of guidelines is to tell you what to do when there is too little time for thought.
Guidelines can be helpful. Usually they are the product of a committee of experts distilling the relevant evidence and setting out what they would do faced with a particular situation. They seek to de®ne good practice. Of course, you need to know how to use guidelinesÐwhen to follow them closely and when to make exceptions. Life has a habit of throwing up the unpredictedÐ perhaps even the unpredictable. I get the feeling that this is not always suf®ciently recognized by our Lords and Masters. (By the way, it's an interesting comment upon the sexism of our culture and language that Ladies and Mistresses would not have quite the same meaning. But I digress). Those at the top whose role isÐor has becomeÐmore managerial than clinical have a tendency to treat guidelines as a kind of holy writ and departure from them as a kind of sin. Or perhaps one could say that they view guidelines as more like tramlines. Personally I like to feel more like a bus.
So, in my view all guidelines need interpretation. They need to be written with this in mind. That, of course, is a tricky business. What we need are some guidelines for writing guidelines and, of course, some guidelines for using guidelines too and then . . . Now writing these higher order guidelines would not be easyÐbut think of the citations if they were successful. A whole new vista opens up. There might even be a new disciplineÐclinical guidance and lineology.
But, enough of all this. What am I going to write for the next issue?