ABSTRACT
How do clinicians collectively make sense of complex matters and agree collective mindlines? This chapter tries to make sense of that process.
™ Extract from interview with Jean: When developing your practice policy on coronary heart disease, did you have any ‘official’ guidelines? ‘Right, probably no, probably not until really the NSF [national service framework] came out I would think, yeah I don’t think we had any specific guidelines I mean I suppose probably what many of us have undoubtedly based things on has been following on from what the consultants do. I mean obviously we all read as well but I think in practical terms you tend to learn from what people come out of hospital on and what the local consultants are doing, I mean for instance although we’re largely still being told that diabetics you know we should still be using charts and looking at them as primary prevention, I mean the local consultants particularly at [Westchurch] I don’t think agree with that. So they generally are treating you know cholesterols that are above five in all of their Type 2s. So personally I think that’s probably more what I’m doing to be honest.’1 So in the absence of any official guidelines how did you as a GP and as a team of GPs agree on standard practice? ‘Right I mean I would say as an individual first of all that I read the BMJ, RCGP journal and so on, which obviously has actually had various editorials and published the major papers to do with coronary heart disease prevention, so I was obviously aware of it in that respect, but again as I say actually seeing what the hospitals do with the patients that I see, so for me it’s both of those things that would really give me guidelines as to what I should be doing, if you see what I mean. As a partnership I suppose that has been a little bit more muddled until the NSF came out, though our nurses have certainly been involved with following up, you know, patients with heart attacks afterwards and we’d agreed to do that. Now I couldn’t tell you really where the guideline came from for that [. . .] We also have to, had to do audits for that and certainly coronary heart disease formed quite a large proportion of the audits that we did for that, so that probably, I suppose actually that [audits for coronary heart disease] probably is partly what sparked quite a lot of the practice change to be honest, yes it probably is. Sorry, as I say it’s sometimes quite difficult when things evolve to remember what order and I expect if you talk to somebody else they’d say something completely different.’
