Woe is Evidence Based Medicine (EBM). When EBM discerns truths, why don't clinicians enthusiastically take them up, to the benefit of patients and budgets?
The limitations of EBM aside, this study considers how real-world clinicians practice and take on new knowledge.
A key concept is ‘mindlines': our own internal guidelines for the messy real world. They are more subtle, broad and pragmatic than research evidence, based on experience and local context. Such guidance, once slowly and rigorously developed, is thus not so easily dislodged by a single message. For new ideas to come into practice, knowledge must be ‘socialised', discussed and internalised by the individual or group.
Possible reasons for clinical inertia are well developed. So what are the lessons for those trying to bring about change? Regrettably this is only tackled more briefly, as a series of pointers in the final chapter.
The ideas in this book offer valuable insight to those involved in quality improvement: clinical leads, policy managers and commissioners. However, there is a great next book waiting to be written for these ideas to be fully realised, including how research can be more relevant and how the management of change specifically relates to clinicians.
Dr Andrew Wheeler is a sessional GP in Gloucestershire