The last frontier? Autonomy, uncertainty and standardisation in general practice

Abstract

Earlier studies, mainly based in the UK, the US, Canada and the Netherlands, indicate that GPs are reluctant to follow guidelines. This study explores the rationale behind GPs’ reluctance to follow guidelines through focus group interviews with Norwegian GPs. A central concern appearing in the interviews is the GPs’ notion of professional identity. The GP was identified as an autonomous generalist with a close alliance to the patient and a sceptical distance to academic medicine and health authorities. Guidelines are seen to conflict with the GPs’ sense of clinical autonomy. Another aspect discussed by the GPs was an authority-based clinical insecurity which made them sceptical about the evidence. The findings highlight the need to ground the debate about standardisation of practice in the practitioners’ professional identity. The study also underlines the importance of transparency in the standardisation process.

Keywords:

• general practice
• guideline adherence
• autonomy
• professional identity
• Norway
• sociology