Why general practitioners do not implement evidence: qualitative study

Abstract

Objectives: To explore the reasons why general practitioners do not always implement best evidence. Design: Qualitative study using Balint-style groups. Setting: Primary care. Participants: 19 general practitioners. Main outcome measures: Identifiable themes that indicate barriers to implementation. Results: Six main themes were identified that affected the implementation process: the personal and professional experiences of the general practitioners; the patient-doctor relationship; a perceived tension between primary and secondary care; general practitioners' feelings about their patients and the evidence; and logistical problems. Doctors are aware that their choice of words with patients can affect patients' decisions and whether evidence is implemented. Conclusions: General practitioner participants seem to act as a conduit within the consultation and regard clinical evidence as a square peg to fit in the round hole of the patient's life. The process of implementation is complex, fluid, and adaptive. What is already known on this topic: General practitioners do not always act on evidence in clinical practice General practitioners are reluctant to jeopardise their relationship with the patient and sometimes feel that patients are unwilling to take drugs What this study adds: Implementation of evidence by general practitioners is a complex and fluid process Decisions are influenced by the doctor's personal and professional experience as well as by their knowledge of and relationship with the patient Doctors' choice of words can influence patients' decisions about treatment