The risks and benefits of the consensus process

The development of consensus and the issuing of consensus guidelines in medicine and in perioperative medicine in particular appear to be potentially useful activities whose impact on patient outcome, however, remains unclear. The current approach based on the creation of semi-arbitrary groups of so-called experts who meet for a period of time, issue statements, guidelines, suggestions, and recommendations has several potential flaws but has not, until recently, been challenged by another approach. The arrival of a Web-based consensus process provides the first challenge to the current model and overcomes some of its limitations while potentially creating others. Which one of the two models will prove empirically superior and will become the dominant paradigm in within a decade or two remains uncertain.