Medicine has developed an almost reflexive incantation that guidelines are not rules, that they exist to inform rather than dictate, to support rather than constrain, and to provide a synthesis of evidence that assists clinical decision-making without supplanting it.

Yet, anyone who has spent sufficient time in practice recognises that this distinction becomes increasingly fragile the moment an outcome is less than ideal.

When something goes wrong, the inquiry rarely begins with a careful examination of reasoning, context or competing risks, but instead with a far more direct question as to whether the guideline was followed, as though adherence itself were a proxy for quality.

In that moment, what was previously described as advisory acquires a retrospective rigidity, transforming into a standard against which deviation must be justified with a level of clarity that few real-time clinical decisions can ever fully satisfy.

This is not to deny the value of guidelines, because within large and complex systems they provide a necessary baseline, a form of coherence that allows care to be delivered with a degree of consistency, particularly in environments where volume is high and experience variable.

And for clinicians earlier in their careers, they offer a framework within which to develop judgement.