Why surgeons don’t follow guidelines

Pope, C. (2000) Why surgeons don’t follow guidelines. Society for Social Medicine annual meeting 2000, Norwich, UK. 05 - 07 Jun 2000.

Abstract

Introduction Widespread and persistent medical and surgical practice variation is held to be a consequence of the failure of clinicians to incorporate research evidence in their everyday work. Practice guidelines are one of the key tactics advocated by the proponents of evidence-based medicine (EBM) to ensure that clinicians apply research evidence to their practice. The critics of EBM contend that there are fundamental differences between the formulised rules encapsulated in guidelines and the type of knowledge required to practise medicine. Much of the opposition to guidelines has been rooted in philosophical arguments about the tensions between "art" and "science", and surgeons, in particular have been quick to argue that the exercise of clinical judgement makes the use of guidelines problematic. The aim of this paper is to suggest why surgeons ignore guidelines.
Methods A qualitative study of 34 surgeons practising urology, gynaecology or pelvic surgery in the UK and USA, involved in treating women with stress urinary incontinence. Qualitative interviews and observational methods were used to explore surgeons' views of surgical practice, to examine the nature of everyday surgical work and consider the applicability of guidelines to this area of medical work. Analysis used techniques of constant comparison to generate themes and categories.
Results Surgeons view surgical work as contingent: they describe it as both dependent on conditional factors and subject to chance. They respond to contingency by drawing on tacit knowledge and instinctive responses. Surgical judgement provides a strong justification for resisting the imposition of guidelines.
Conclusion The technical knowledge embodied in guidelines may be difficult to reconcile with the individual and practical nature of everyday surgical work.

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Contributors

Author: C. Pope

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