The significance and effect of guidelines 2. Observations concerning validation and recommendations with respect to guidelines

The proper functioning of guidelines depends in part on correct validation. Validation requires an established norm. The professional and proto-pro­fessional paradigm uses different standards for validation based on different epistemological assumptions. Several different fundamental principles are also applied among healthcare professionals themselves. This leads to an insurmountable methodological difference whereby validation is not possible or meaningful at the moment. An important role seems reserved for the epistemology of the humanities to explain and interpret the guidelines. In addition, the operationalization of guidelines does not seem to be straightforward. The use of guidelines shows that unintended effects, such as the exclusion of patients from insurance and reimbursement, arise. In addition the number of guidelines is increasing to such an extent that implementation and enforcement are in danger of being compromised. Recommendations are made to monitor the significance and effect of guidelines.