Changes in perceived effect of practice guidelines among primary care doctors

Abstract

The perceived effect of practice guidelines on primary care doctors increased over time. Improved dissemination of guidelines and curriculum changes may have led recent primary care graduates to view practice guidelines as more important.

Physicians' Undecided Attitudes Toward Posthumous Reproduction: Fertility Preservation in Cancer Patients with a Poor Prognosis

“…Knowledge of guidelines, not whether they followed the guidelines or not, influenced whether physicians discussed fertility issues with patients with a poor prognosis. Guidelines can improve quality of care but do not always correlate with a change in clinical practice (Cheng, Nieman et al 2007; Han, Klabunde et al 2011). Religion was specifically related to beliefs about FP in patients with a poor prognosis and posthumous reproduction with physicians of Jewish religion having more negative attitudes.…”

Medicine and evidence: knowledge and action in clinical practice

“…Having considered doctors’ views on and knowledge of EBM concepts, methods and terminology, we move now to a set of four articles [57–60] examining doctors’ views of clinical practice guidelines and the factors which mediate their implementation and use in routine clinical practice. In the first article, Harder and her co‐workers [57] describe their qualitative study which mapped Saskatchewan doctors’ views on the implementation of clinical practice guidelines.…”

“…In the final paper of this set, Cheng and his colleagues [60], similarly focussing on primary care medicine, examine possible changes in the attitude of family doctors to the use of practice guidelines that may have taken place in recent years in the USA. The authors report a significant increase over their 5‐year period of study in the proportion of primary care doctors acknowledging at least a moderate effect of practice guidelines on their practise of medicine, with important gender differences being observed and a significant influence of date of graduation and of the complexity of the health care environment in which a doctor works.…”

“…While some researchers (including authors whose contributions we are happy to include in this journal [43,49,50,54–60]) might be inclined to see the work of research as identifying and (in some cases) considering ways to solve this ‘problem’ for the implementation of EBM, it is surely appropriate, in the interests of open debate about a matter of profound import for the future of medical practice, to raise also the more fundamental, philosophical question of how we characterise ‘the problem’ here. It is at least possible to argue that the real problem is the attempted imposition of a set of dogmas and practices upon a working population, in the absence of any demonstration of its benefits, the truth of its key claims nor even a detailed and consistent exposition of their meaning.…”

“…Far from having been settled, we contend that the most pressing, intellectually demanding and practically challenging questions of medical epistemology remain open. This is why we welcome not only contributions from within the EBM camp [43,49,50,60], but also from those whose concern is not to see how well EBM is being implemented but to question, in a variety of different and sometimes incompatible ways, whether it can and should be implemented at all . If this position seems radical or eccentric to some then they need to examine their own expectations about the nature and scope of proper academic debate: for how can it be eccentric to promote open and rigorous debate of unresolved and fundamental questions that promise to shape our conceptions of medical knowledge and practice in future?…”