Clinical practice guidelines are becoming an important determinant of how we practice medicine and surgery. They are the strategy of our federal agencies to reduce variability in care, improve quality, measure outcomes, and reduce costs. The payors and entrepreneurs of medicine have endorsed the use of practice guidelines as the most efficacious way to manage costs, and variability. This economic force alone will perpetuate their development in the foreseeable future. It could be tempting to recoil from these pressures that may seem outside the realm of the individual surgeon trying to do the best for the individual patient. However, when viewed as a way to work with our colleagues and use scientific evidence and expert opinion to achieve consensus about best practice, this effort is very much in line with the way we practice surgery. The surgical community should not be concerned with participating but, in fact, should lead. The surgical tradition with outcomes assessment-the Morbidity and Mortality Conference-is a fundamental principle used to improve care. The process of practice guideline development is designed to do the same to continuously improve care.