ABSTRACT
The place of evidence-based practice in recent healthcare reforms This book explores how clinicians1 acquire and use their knowledge. They know they are expected to ensure that they adhere to the latest, preferably researchbased, evidence about best practice, yet they do not always make the best use of the new sources of evidence such as clinical guidelines and systematic reviews of clinical trials (Haynes 1993; Lomas 1997; Evans and Haines 2000; Armstrong 2002; Haines et al. 2004; Wyer and Silva 2009). That conundrum is set against a background of health professions that are in a state of flux (Peckham and Exworthy 2003; Klein 2001; Harrison and McDonald 2008). Even by the 1990s the reputedly omniscient senior physician, the dependably avuncular general practitioner, the handmaiden nurse and the acquiescent patient were already disappearing. Across the health professions, where the traditional hierarchies were tumbling, new relationships between professionals were emerging (see, for example, Ashburner and Birch 1999; Childs 2008) with general practitioners employing increasingly larger numbers of nurse practitioners and indeed in some rare instances doctors and nurse practitioners combining on an equal footing to form general practices. Since then multidisciplinary teams have been increasingly expected to break down the old pecking order; innovative roles such as nurse practitioners and physicians’ assistants have been blurring professional boundaries. Patients – gradually becoming relabelled as ‘clients’ by some health professions to stress this very point – seem often to know a great deal about, and are ever more encouraged to have a strong say in, how their illnesses are managed. To that end they now have potential access to rich resources of knowledge and advice not only through patients’ organizations but through the internet. Clinicians too are faced with many more sources of knowledge that they need to take account of when practising.
