Power and influence in clinical effectiveness and evidence-based medicine

Abstract

GPs are seen as having less expert power than consultants and to be more compliant with externally managed guidelines and audit programmes. It is pointed out that compliance with guidelines and audit programmes helps GPs to meet their contractual requirement to be involved in clinical audit activities. Evidence-based practice, which directly challenges the authority of expert opinion is seen as a threat to the power of consultants, but a potential opportunity for GPs and other clinicians whose status is traditionally lower.

Purifying and hybridising categories in healthcare decision-making: the clinic, the home and the multidisciplinary team meeting

“…Developments in evidence-based medicine and practice guidelines have been thought to undermine traditional clinical expertise, as clinicians are increasingly required to point to an external evidentiary authority in order to provide justification for their decisions, as opposed to relying on their own experience (Lipman, 2000). Further challenges to clinical autonomy come from such developments as multidisciplinary teams where medical practitioners draw on the expertise of different specialties to make evidence-based recommendations for patient management (Patkar et al, 2011), which potentially cedes some of their autonomy to other health professionals.…”

Risk Reduction Technologies in General Practice and Social Work

“…Here, too, it was possible to distinguish three variants of ambivalence: 1) the difficulty in applying EBM when it clashed with personal experience, 2) the experience of EBM as a top-down model that left limited or no room for the GPs' own clinical expertise, 3) the difficulty of assessing and applying EBM when the sources of knowledge behind the evidence were numerous and not always unanimous (Andersson et al, 2002(Andersson et al, , 2005Beaulieu et al, 1999;Cabana et al, 1999;Carlsen & Frithjof;2005;Gabbay & le May, 2004;Grol & Grimshaw, 2003;Hannes et al, 2005;Lewis & Tully, 2009;Lipman, 2000;Shuval et al, 2007).…”

“…They also raised critique towards the lack of evidence to support any benefits of the needs assessment (Beaulieu et al, 1999;Cabana et al, 1999;Murie et al, 2000). They argued that needs assessment belonged to the realm of politics and fell outside the core of their jurisdiction (Lipman, 2000;Murie et al, 2000).GPs further stated that they lacked appropriate training in needs assessment and that it increased their workload. However, some studies indicated that physicians were positive towards needs assessment (Murie et al, 2000;Petchey, 1994;Willems, 2001).…”

AGREEing on Canadian cardiovascular clinical practice guidelines

“…The limitations of CPGs are frequently and loudly trumpeted by those disinclined to adhere to health maintenance or disease management recommendations not of their own design or inception (6)(7)(8)(9). With respect to individual patient care, CPGs that are inflexible may help to standardize care and increase the consistency of service delivery, but may ultimately limit individualized care (17,18).…”

“…Perhaps surprisingly, this care gap is not secondary to any overt or measurable knowledge gap regarding what information is contained within national CPGs, but instead represents a distinct 'action gap' in the behaviour of health care professionals in the application of CPG recommendations to their own patients (5). Tenable explanations for this action gap include the possibilities that some medical and health care professionals may actually distrust CPGs, they dismiss them as oversimplified, 'cookie-cutter' or 'one-size fits all' approaches to the complex art of clinical practice, or they may believe that CPGs lag behind recent convincing evidence and choose to follow their own evidence (6)(7)(8). This lamentable situation for patients comes from, in part, the belief among some key opinion leaders that "eminence-or experience-based practice" is infinitely more reliable and clinically more relevant than contemporary CPGs (9).…”