These two articles were published in the January 2006 issue of the Journal of Evaluation in Clinical Practice. Currently, this issue is free online.
Genuis, Shelagh K. & Genuis, Stephen J. Exploring the continuum: medical information to effective clinical practice. Paper I: the translation of knowledge into clinical practice. Journal of Evaluation in Clinical Practice 2006; 12 (1), 49-62.
This paper investigates the translation of medical information into clinical practice and the role of thoughtful dissent by exploring the influence of sociological factors on change, the impact of evidence-based medicine (EBM), and the role of industry. Changing practice related to hormone therapy for menopausal and post-menopausal women provides context for this discussion. Medical change involves diffusion of ideas to potential users and ongoing reconciliation of new information with old ideas; this process is influenced by sociological factors including values and experiences, interpersonal relationships and local context. While EBM has alerted doctors to the importance of high quality research and theoretically provides a tool for translating research into practice, there are important problems with its application:
(1) it has resulted in a reductionist approach to research and illness;
(2) there is a considerable gap between research findings and the complex environment of clinical practice; and
(3) EBM has been appropriated by experts, thus corporately developed 'standard-of-care' documents have become instruments of external regulation, and EBM has ceased to be a tool in the hand of individual clinicians. In addition, industry impacts the translation of knowledge by significantly influencing academia, researchers, medical publications, consensus conferences, and practising doctors. While questioning doctrinaire practices or directives is a daunting prospect for individual clinicians, the translation of knowledge into practice and evolution of medical thought is dependent on the progressive role of thoughtful dissent.
DOI Link [free full text]
Genuis, Stephen J. & Genuis, Shelagh K. Exploring the continuum: medical information to effective clinical practice. Paper II. Towards aetiology-centred clinical practice. Journal of Evaluation in Clinical Practice 2006; 12 (1), 63-75.
Contemporary clinical practice increasingly functions within a disease management paradigm aimed at finding and implementing therapeutic interventions that demonstrate efficacy in clinical trials. Disease prevention, elucidation of illness aetiology and proactive health promotion have taken a back seat. Current clinical care often includes a 'fast-food' type of medical encounter, which frequently neglects disease causality. The medical community is presently challenged by unique administrative and professional adversities as well as undue commercial influence; these factors contribute to a lethargic response to escalating rates of chronic illness and to mainstream medicine's relative inattention to emerging research about disease aetiology. Individual medical practitioners and the medical establishment must strategically seek to advance patient health and maintain professional relevancy by a renewed emphasis on the following principles: patient-based clinical care, aetiology-centred medicine, and proactive health promotion.
DOI Link [free full text]