JMIR Publications

ABSTRACT

Background:

Numerous published articles show that physicians do not follow clinical practice guidelines. However, few studies explore what physicians consider evidence and how they use different forms of evidence in their care decisions. Many of the existing studies on how physicians use evidence occurred before the advent of smart phones and advanced online information retrieval technologies.

Objective:

It is important to understand how these new technologies influenced the ways that physicians use evidence in their practice.

Methods:

In this paper, we draw on ethnographic data collected through shadowing internal medicine teams at two teaching hospitals to understand the roles that scientific evidence plays for attending physicians and trainees when caring for patients.

Results:

Clinical practice guidelines represent just one of several sources of scientific evidence that are used when making care decisions. The majority of scientific evidence was accessed online, often through smart phones. Forms of evidence were used differently depending on the level of experience of the person drawing on the evidence and were often blended together to arrive at shared understandings and approaches to patient care. In applying evidence to care, internal medicine team members are cognizant that scientific evidence is evolving, occasionally of low quality, can make competing claims, and does not cover all clinical problems. In moving from incorporating summaries of scientific evidence to primary sources of scientific evidence into their care decisions, trainees and attending clinicians increasingly add scientific uncertainty to the medical uncertainty that is inherent in their practice.

Conclusions:

This paper outlines one way that the ethos of evidence-based medicine has been incorporated into the daily work of care. Here multiple online forms of evidence were mixed with other information. This is different from the pathway that is often articulated by health administrators and policy makers whereby clinical practice guideline adherence is equated with practicing evidence-based medicine.