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Professionalism, Indeterminacy and the EBM Project

Published online by Cambridge University Press:  01 March 2007

David Armstrong
David Armstrong
Affiliation:
Department of General Practice, King’s College London, 5 Lambeth Walk, London SE11 6SP, UK E-mail: david.armstrong@kcl.ac.uk
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Abstract

Who controls indeterminacy in the doctor–patient encounter defines the nature of professional power. Evidence-based medicine (EBM) is one such control strategy claiming to reduce uncertainty by identifying effective (and efficient) interventions and by removing ineffective treatments from clinical practice. EBM, however, as a means of keeping some autonomy for a profession beset by increasing government control, has had to compete with other professionalizing strategies within medicine. And, despite its promise, EBM is shown not to have reduced indeterminacy but to have shifted the problem into a wider policy arena that involves interpreting evidence. Moreover, in an era of concern for patient safety, EBM is proposed as part of a solution (through its claim to reduce uncertainty about the effect of interventions) but remains itself a potent source of danger and increased indeterminacy.

Keywords

EBMindeterminacyprofessions

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Type
Articles
Information
BioSocieties , Volume 2 , Issue 1: Special Issue: The Construction and Governance of Randomised Controlled Trials , March 2007 , pp. 73 - 84
Copyright
Copyright © London School of Economics and Political Science 2007

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References

Armstrong, D. (2002). Clinical autonomy, individual and collective: A qualitative study of changing GPs’ behaviour. Social Science and Medicine, 55, 1771–1777.CrossRefGoogle Scholar
Armstrong, D. (2006). Embodiment and ethics: constructing medicine’s two bodies. Sociology of Health and Illness, 28, 951–968.CrossRefGoogle ScholarPubMed
Byrne, P.S., & Long, B.E.L. (1976). Doctors talking to patients: A study of the verbal behaviour of general practitioners consulting in their surgeries. London: HMSO.Google Scholar
Carlisle, D. (2006). A furore too far: The widespread disquiet undermining NICE. Health Services Journal, 116, 14–15.Google ScholarPubMed
Chalmers, I., Rounding, C., & Lock, K. (2003). Descriptive survey of non-commercial randomised controlled trials in the United Kingdom, 1980–2002. British Medical Journal, 327, 1017.CrossRefGoogle ScholarPubMed
Cochrane, A.L. (1972). Effectiveness and efficiency. Oxford: Nuffield.Google Scholar
Coulter, A. (1997). Partnerships with patients: The pros and cons of shared clinical decision-making. Journal of Health Services Research and Policy, 2, 112–121.CrossRefGoogle Scholar
Coulter, A. (2002). The autonomous patient: Ending paternalism in medical care. London: Stationery Office and Nuffield Trust.Google Scholar
Davidoff, F., Haynes, B., Sackett, D., & Smith, R. (1995). Evidence based medicine. British Medical Journal, 310, 1085–1086.CrossRefGoogle ScholarPubMed
Department of Health (2005). Creating a patient-led NHS: Delivering the NHS Improvement Plan. London: HMSO.Google Scholar
Elwyn, G., Edwards, A., & Kinnersley, P. (1999). Shared decision-making in primary care: the neglected second half of the consultation. British Journal of General Practice, 49, 477–482.Google ScholarPubMed
Ferner, R.F., & McDowell, S.F. (2006). How NICE may be outflanked. British Medical Journal, 332, 1268–1271.CrossRefGoogle ScholarPubMed
Freedman, B. (1987). Equipoise and the ethics of clinical research. New England Journal of Medicine, 317, 141–145.CrossRefGoogle ScholarPubMed
Fox, R.C. (1957). Training for uncertainty. In Merton, R.K.Reader, G. & Kendall, P. (Eds), The student physician. Cambridge, MA: Harvard University Press.Google Scholar
Freidson, E. (1970). Profession of medicine. New York: Dodd, Mead.Google Scholar
Haines, A., & Donald, A. (Eds) (1998). Getting research findings into practice. London: BMJ Books.Google Scholar
Haug, M. (1973). Deprofessionalization: An alternative hypothesis for the future. Sociological Review Monograph, 2, 195–211.Google Scholar
Illich, I. (1976). Medical nemesis. London: Marian Boyars.Google Scholar
Jewson, N.D. (1976). The disappearance of the sick-man from medical cosmology, 1770–1870. Sociology, 10, 225–244.CrossRefGoogle Scholar
Johnson, T.J. (1972). Professions and power. London: Macmillan.Google Scholar
Lee, J., & O’Morain, C. (1997). Consensus or confusion: A review of existing national guidelines on Helicobacter pylori-related disease. European Journal of Gastroenterology and Hepatology, 5, 527–531.CrossRefGoogle Scholar
Levenstein, J.H., McCracken, E.C., McWhinney, I.R., Stewart, M.A., & Brown, J.B. (1986). The patient-centred clinical method, 1: A model for the doctor–patient interaction in family medicine. Family Practice, 3, 24–30.CrossRefGoogle Scholar
Light, D. (1979). Uncertainty and control in professional training. Journal of Health and Social Behaviour, 20, 310–322.CrossRefGoogle ScholarPubMed
McKinlay, J., & Stoeckle, J. (1988). Corporatisation and the social transformation of doctoring. International Journal of Health Services, 18, 191–205.CrossRefGoogle Scholar
Misselbrook, D., & Armstrong, D. (2001). Patients’ response to risk information about the benefits of treating hypertension. British Journal of General Practice, 51, 276–279.Google ScholarPubMed
MRC (Medical Research Council) Working Party (1985). MRC trial of treatment of mild hypertension: Principal results. British Medical Journal, 291, 97–104.CrossRefGoogle Scholar
Poulter, N.R.BHS Executive Committees (2004). NICE and BHS guidelines on hypertension differ importantly. British Medical Journal, 329, 1289.CrossRefGoogle ScholarPubMed
RCP Working Party Report (2005). Doctors in society—Medical professionalism in a changing world. London: Royal College of Physicians.Google Scholar
Roberts, I., Yates, D., Sandercock, P., Farrell, B., Wasserberg, J., Lomas, G. et al. (2004). Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): Randomised placebo-controlled trial. The Lancet, 364, 1321–1328.Google ScholarPubMed
Sackett, D.L., & Rosenberg, W.M. (1995). The need for evidence-based medicine. Journal of the Royal Society of Medicine, 88, 620–624.CrossRefGoogle ScholarPubMed
Sackett, D.L., Rosenberg, W.M., Gray, J.A., Haynes, R.B., & Richardson, W.S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312, 71–72.CrossRefGoogle ScholarPubMed
Starr, P. (1982). The social transformation of American medicine. New York: Basic Books.Google Scholar
Topol, E.J. (2004). Failing the public health—Rofecoxib, Merck, and the FDA. New England Journal of Medicine, 351, 1707–1709.CrossRefGoogle ScholarPubMed
US Institute of Medicine (1999) To err is human: Building a safer health system. Washington, DC: Institute of Medicine.Google Scholar