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Evidence-based drive 'unethical'

The obsessive drive towards evidence-based targets and quality payments has serious ethical implications and could impinge on patient choice, according to GP researchers.

A study in the latest issue of Journal of Medical Ethics concluded the increasing focus

on evidence-based medicine could distort clinical priorities.

Dr Anne Slowther, research fellow at the Oxford Centre for Ethics and Communication in Healthcare Practice and a GP locum, said policymakers should be wary of relying solely on randomised controlled trials for evidence-based guidance because of the complexity of disease in primary care.

'I would question whether we have got the balance right because flagging up other evidence such as qualitative studies and patient experience is important. The lack of flexibility in evidence-based guidance limits GPs when taking into account patient wishes or personal experience,' she said.

She warned inequalities could increase as resources are focused on the areas with the strongest evidence and expressed concern at the increasing popularity of targets and financial incentives.

But Professor Martin Rol-and, director of the National Primary Care Research and Development Centre in Manchester and a member of the team that wrote the quality framework, said: 'There should be no dichotomy – the skilled GP incorporates both evidence-based and patient-centred medicine. The role of the profession is to interpret the evidence in the light of the patient's own circumstances.'

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