title: EBM: evidence to practice and practice to evidence.
abstract: BACKGROUND
  The purpose of this paper is to explore new perspectives about difficulties academicians may have communicating with clinicians, obtaining subjects, and gaining compliance for their research.
  
  
  OBJECTIVE
  Evidence-based medicine (EBM) has been defined as an integration of best research evidence, clinical expertise, and patient values; however, clinical observation and experience are placed last in the evidence hierarchy with the randomized controlled trial held as the standard for clinical intervention. This paper describes how the hierarchical model of power in the research community obstructs new areas of knowledge, and how clinicians create resistance. Methods Foucault gave new perspectives describing how power circulates through individuals within organizational discourse. Drawing on literature and experience, and using a framework based on postmodern theoretical concepts, this paper examines patterns of discourse, subjectivity, resistance, and power/knowledge within the physical therapy profession.
  
  
  RESULTS
  The hierarchical discourse of medical knowledge produces opposition rather than collaboration between researcher, clinician, and patient. Alleviating perceptions of dominance and creating connections produces cohesion within medical communities.
  
  
  CONCLUSIONS
  Evidence to practice and practice to evidence redefines EBM as a circular integration of best research evidence, clinical expertise, and patient values.
authors.affiliation: Center for Women's Health Research, University of Wisconsin-Madison, Madison, WI, USA. cisaac@wisc.edu
authors.forename: Carol A
authors.initials: CA
authors.lastname: Isaac
authors.forename: Amy
authors.initials: A
authors.lastname: Franceschi
mesh_terms: D001291:Attitude of Health Personnel; D015510:Clinical Medicine / Q000458:organization & administration; D003142:Communication; D003299:Cooperative Behavior; D004059:Diffusion of Innovation; D034462:Dissent and Disputes; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007400:Interprofessional Relations; D019359:Knowledge; D009341:Negativism; D018802:Patient-Centered Care / Q000458:organization & administration; D010686:Philosophy, Medical; D033302:Postmodernism; D011209:Power, Psychological; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012930:Social Dominance