In the 1950s, US Secretary of Defense Charles Wilson coined the phrase getting a “bigger bang for the buck.” The meaning is simple: When presented with a variety of options, choose the one that will provide the best value. This is true for physicians when faced with a diagnostic dilemma and a myriad of options from which to choose. The best first test for a patient often requires the physician to choose the one that provides maximal information with minimal risk. For common diseases, there often are evidence-based clinical practice guidelines (CPGs) that can provide direction for physicians. They are created by content area experts in collaboration with formally trained methodologists. Ultimately, however, they are only as good as the paper they are written on unless they can be widely disseminated and broadly implemented. But what happens when adherence to guideline-directed care is lacking? In this issue of CHEST (see page 1776), Almeida and colleagues1 provide a clear answer: Patients suffer.