The results show both positive and negative effects of guideline exposure, but only in the training group and not in the information group. Guidelines should be empirically tested before being called "evidence based". Every guideline should also explain how it can or must be implemented in order to become effective.

Die Behandlung von Patienten, und damit medizinisches Tun als solches, besteht aus einer Folge von Entscheidungen über diag− nostische Maßnahmen, die Interpretation von Befunden, die Auswahl von Therapien oder die Durchführung von Interventi− onsmaßnahmen. Ärzte müssen in der Begegnung mit ihren Pa− tienten ständig medizinische Entscheidungen fällen darüber, welche Klagen des Patienten sie ernst nehmen und welche sie ignorieren, welche diagnostischen Untersuchungen sie wann

As part of an international WHO study on psychological disorders in primary health care, patients were examined for mental disorders and especially depression and social disability in the course of 1 year. Depression is common in primary care (8.6%) and frequently associated with recurring or chronic courses (33.3%). Depression at baseline leads to a 100% increase of lost working days (3.2 per month) 1 year later as compared to patients without depression (1.7). The diagnosis of depression at baseline poses a greater risk for a relevant and lasting psychosocial disability (28.2%) than e.g. chronic somatic illnesses (8.6%). Even the diagnosis of a subthreshold depression leads comparatively to a higher degree of psychosocial disability (15.6% of patients) and days of absenteeism at work during the last month (2.9 days).

Guideline exposure did not reach its goal in respect to the recommended dosage. It missed its goal in respect to improvement of outcome and even showed negative effects. Guidelines should be evidence-based not only by referring to literature reviews but by testing their clinical effects in controlled clinical trials.