Clinical autonomy, individual and collective: the problem of changing doctors' behaviour
David Armstrong
Social Science & Medicine, 2002, vol. 55, issue 10, 1771-1777
Abstract:
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.
Keywords: Primary; care; Doctor-patient; interaction; Evidence; based; Medicine; Patient-centred; medicine; UK (search for similar items in EconPapers)
Date: 2002
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