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Samuel Durso, MD, MBA

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

As a framework, Braithwaite et al¹ offer a useful tool for quantifying risk and harm for a particular type of clinical guideline—one in which the benefit occurs subsequent to the harm. They cite colonoscopy as an example. Furthermore, they state that this condition (ie, benefit following harm) occurs often in clinical practice guidelines. This may be overstating the case. While the tool is conceptually useful (and I will use it), this type of practice recommendation probably represents a small fraction of the relevant clinical practice guideline recommendations that physicians must consider when caring for older adults with multiple chronic illnesses. For example, in the study by Boyd et al,² a significant proportion of the recommendations for 10 of the most prevalent diseases in older adults (eg, hypertension, chronic heart failure, stable angina, atrial fibrillation, hypercholesterolemia, diabetes mellitus, osteoarthritis, chronic obstructive pulmonary disease, and osteoporosis) involved long-term . . . [Full Text of this Article]

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