Evidence That There Are A Lot Of Barriers To Doctors Using Evidence

In this synthesis of qualitative studies evaluating physicians’ attitudes towards and use of evidence-based medicine (EBM), many barriers and a few facilitators to utilitzation of EBM were identified.  The main facilitators were: having a positive attitude toward EBM; having supervisors, clinical role models, or respected colleagues who valued EBM; access to “summarized, clinically oriented, and user-friendly information”, and being in a culture that fostered “respectful and reciprocal communication” about evidence.  Barriers were much more numerous:  disagreeing with the definition of EBM as “the translation of best evidence and clinical expertise into individualized patient care”; suspicion of potential abuse of EBM by others; fear of losing professional autonomy; satisfaction with familiar routines; older age; having a “very strong, inflexible, or insecure personality”; being in a culture dominated by an “expert-based pecking order and nonreciprocal communication”; lack of EBM knowledge and skills; view of EBM as too time consuming; appreciation of the “rapid growth and replacement of evidence”; unawareness of own knowledge gaps; preference for getting information from colleagues and pharmaceutical representatives; attitude that patients are “unable to understand research evidence or to tolerate its inherent uncertainty”; wishing to avoid conflicts with patients; systemic and organizational barriers; and lack of EBM resources, time, mentors, training, and financial incentives.  This reviewer found the synthesis depressing, as without the incorporation of best evidence into our care, doctors will “make the same mistakes with increasing confidence over an impressive number of years.” – Laura Willett, MD

Swennen MH, van der Heijden GJ, Boeije HR, van Rheenen N, Verheul FJ, van der Graaf Y, Kalkman CJ., Doctors’ Perceptions and Use of Evidence-Based Medicine: A Systematic Review and Thematic Synthesis of Qualitative Studies. Acad Med. 2013 Sep; 88(9):1384-1396.

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