Clinical autonomy, individual and collective: the problem of changing doctors' behaviour.
Evidence-based medicine enables the profession to resist at least some of the challenges to its traditional autonomy: if informed doctors provide what is scientifically proven to be the best care there is less justification for external constraints. Yet, this defensive strategy depends on enforcing a new discipline within the profession such that individual practitioners accept mechanisms of external 'decision support' in their clinical practice. A study of the ways in which general practitioners in British Primary Care change their clinical behaviour shows that an emphasis on a 'patient centred' approach establishes an alternative individualised autonomy that seems inimical to the logic of evidence-based medicine. A tension therefore emerges between the maintenance of the autonomy of the profession as a collectivity through the promotion of a therapeutic rationality and the maintenance of the autonomy of the individual practitioner through the rhetoric of patient-centredness.
Armstrong
David
D
GKT Department of General Practice and Primary Care, King's College London, 5 Lambeth Walk, SE11 6SP, London, UK. david.armstrong@kcl.ac.uk
D001291:Attitude of Health Personnel; D020000:Decision Support Systems, Clinical; D004739:England; D019317:Evidence-Based Medicine; D006801:Humans; D007407:Interviews as Topic; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards; D017009:Professional Autonomy