Challenges are often encountered when implementing guidelines into clinical practice. Here, Guy Pratt, MD, FRCP, FRCPath, of the University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK, discusses some of these issues within the field of multiple myeloma (MM). Dr Pratt explores how the introduction of new drugs into clinical practice is hindered due to not only cost, but a lack of insight into how exactly these drugs should be utilized, with regards to combining therapies and duration of administration. Dr Pratt proceeds to discuss how survey data from across the UK provides further insight into the difficulties of guideline implementation, with evidence suggesting that most centers are still using skeletal surveys within MM diagnostics - contrary to guidelines suggesting the use of improved cross-sectional imaging modalities. This is suggestive of capacity and cost being a major issue within guideline implementation, implying the importance of leveraging real world data over clinical trials when assessing the efficacy of guidelines.