title: Clinical inertia, uncertainty and individualized guidelines.
abstract: Doctors often do not follow the guidelines of good practice based on evidence-based medicine, and this "clinical inertia" may represent an impediment to efficient care. The aims of this article are as follows: 1) to demonstrate that this phenomenon is often the consequence of a discrepancy between the technical rationality of evidence-based medicine and the modes of reasoning of physicians practiced in "real-life", which is marked by uncertainty and risk; 2) to investigate in this context the meaning of the recent, somewhat paradoxical, concept of "individualized guidelines"; and 3) to revisit the real, essentially pedagogical, place of guidelines in medical practice.
authors.affiliation: Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital, AP-HP, EA 3412, CRNH-IdF, University Paris 13, Sorbonne Paris Cité, 125, route de Stalingrad, 93000 Bobigny, France. Electronic address: gerard.reach@avc.aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Reach
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D010820:Physicians; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012306:Risk; D035501:Uncertainty
keywords: Clinical inertia; Emotions; Evidence-based medicine; Heuristics; Individualized guidelines; Uncertainty