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Do We Use Guidelines or Mindlines?

Kenneth Y. Tsai, MD, PhD

Arch Dermatol. 2005;141:773-774.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Commentary on: Evidence-based guidelines or collectively constructed "mindlines?" ethnographic study of knowledge management in primary care.
Gabbay J, le May G
BMJ. 2004;329:1013.

Question:To what extent do primary care medical practitioners (physicians, nurses, support staff, trainees) actually use explicit research evidence in day-to-day practice; how are decisions regarding practice guidelines made at the collective and individual practice levels; and what sources of knowledge do practitioners most commonly use?

Methods: An ethnographic study of 2 general medical practices in England, one in a rural area and the other in an urban one. Methods of nonparticipant observation, interviews, and review of guidelines and practice guidelines were used. The subjects included 9 physicians, 3 nurses, 1 phlebotomist, and associated medical staff.

Results:

1. There was no evidence that practitioners went through the steps of rational evidence-based medicine (EBM) practice. Subjects were not observed reading available clinical guidelines . . . [Full Text of this Article]