Physicians reveal five strategies for handling conflicting medical guidelines

Physicians in outpatient care face conflicting clinical practice guidelines, and a new qualitative study set out to identify how they manage them. A new qualitative study published in BMC Primary Care documents how outpatient physicians actually navigate this growing problem, identifying five distinct strategies they use to manage conflicting clinical practice guidelines. The findings come from semi-structured interviews with 20 physicians practicing in outpatient care settings, analyzed through inductive qualitative content analysis.

The research team included Hoda Fakhari, Courtney L. Scherr, and colleagues, and the study was published in BMC Primary Care. The participant pool included 11 attending physicians, 8 residents, and 1 fellow; 10 practiced family medicine, 7 general internal medicine, and 3 an internal medicine subspecialty. Because the study used semi-structured interviews with qualitative content analysis, it documents physicians' strategies for managing conflicting guidelines rather than measuring effects on clinical or patient-centered outcomes.

Clinical practice guidelines exist to translate evidence into recommendations for preventing and managing medical conditions, with the goal of improving healthcare quality and outcomes. But the study’s background notes that as guidelines proliferate across sources and evolve over time, conflicting recommendations have become increasingly prevalent. This creates a significant challenge for both clinical decision-making and adherence to practice recommendations, and the researchers point out that knowledge about how physicians actually manage such conflicts has been limited.

Participants widely acknowledged that conflicting guidelines are common in their daily practice. The interviews surfaced five strategies. First, physicians employ clinical judgment to personalize guidelines, adapting recommendations to the individual patient in front of them. Second, they seek additional information. Third, they rely on the most familiar or preferred source.

The fourth strategy is shared decision-making. The fifth is more consequential: some physicians proceed with the more aggressive clinical recommendation when guidelines disagree. The study's authors describe this mix as combining established standard-of-care practices with heuristic-based techniques.

The researchers note that some of the identified approaches promoted more personalized application of guidelines, potentially aligning care more closely with individual patient circumstances. The study did not test whether any strategy produces better outcomes; it documented what physicians report doing.

The authors are explicit about the limits of their evidence. Because the work is qualitative and based on interviews with 20 physicians in outpatient care, it cannot establish the effects of these strategies on clinical and patient-centered outcomes. The researchers call for more research to determine the effects of the identified physician strategies on those outcomes, and to examine how the presence of conflicting guidelines affects dissemination and implementation outcomes.

The study's title borrows the phrase, "What day is it, there's a different guideline," reflecting the prevalence of conflicting guidelines that participants widely acknowledged. The article was published open access on 4 November 2026 and is citable with a permanent DOI, though the early-release version remains subject to further edits before the final Version of Record replaces it.

Subject of Research: How outpatient physicians manage conflicting clinical practice guidelines

Article Title: “What day is it, there’s a different guideline”: how physicians manage conflicting clinical practice guidelines in outpatient care settings

Article References: Fakhari, H., Kerstiens, S., Moe, S., Hoell, C., Smith, M. E., Rasmussen-Torvik, L. J., Chisholm, R. L., McNally, E. M., & Scherr, C. L. (2026). “What day is it, there’s a different guideline”: how physicians manage conflicting clinical practice guidelines in outpatient care settings. BMC Primary Care. https://doi.org/10.1186/s12875-026-03634-6

Image Credits: AI Generated

DOI: 10.1186/s12875-026-03634-6

Keywords: clinical practice guidelines, conflicting guidelines, outpatient care, physicians, qualitative research, semi-structured interviews, clinical decision-making, shared decision-making, primary care, guideline adherence, medical recommendations, there