Language for Actionable Recommendations in Clinical Guidelines: Avoiding Hedging and Equivocation

A marked discrepancy exists between the nature of the guidance that physicians provide as individuals and the guidance provided by professional societies. Guidance between individual physicians—for example, during patient handoffs—often tends to be brief and directive, often communicated in the form of to-do lists. Guidance from societies, predominantly in the large body of intermediate-grade recommendations from practice guidelines (eg, class IIA and class IIB in the American Heart Association classification), is often couched in equivocation that runs counter to the Institute of Medicine’s charge that “Practice guidelines should use unambiguous language.…”1 This admonition is more than an element of style, as data suggest that there are limitations in physicians’ understanding of practice guideline recommendations.2