Professional judgement and the role of clinical guidelines and evidence-based medicine (EBM): Netherlands, Britain and Sweden

Abstract

This comparative study of doctors in the Netherlands, Britain and Sweden concerns the issue of professional self-regulation in the workplace. Medical protocols, clinical guidelines and evidence-based medicine (EBM) are discussed in connection with the issues of medical autonomy and managerial control. This new generation of ‘professional quality control’ threatens to replace pre-existing medical audit practices in the wake of the introduction of ‘managed care’ and regulated markets. These practices seem to ‘square the circle’ between contracted managed care and medical autonomy. In the process, however, they appear to reduce the area of discretion for the hospital specialist. If procedures are carried out that conflict with agreed ‘protocols’ doctors appear to leave themselves open to litigation. What is sociologically interesting are the differences of approach adopted within the three countries. These will inform the discussion of the responses of the organised medical professions.

Key Words:

• Clinical guidelines
• evidence-based medicine (EBM)
• Netherlands
• Britain
• Sweden