General Practitioners, specialists and surveillance guidelines: Interpreting the socio-clinical context of decision-making

Abstract

In contemporary times, evidence-based medicine is used as the basis for clinical decision-making. For a great number of diseases, surveillance guidelines, which are informed by evidence-based medicine, have been drawn up with much input from specialists in their relevant fields. However, these guidelines are implemented in general practice where different rationalities are brought to bear on clinical decision-making. This qualitative study interviewed both specialists and General Practitioners in New Zealand about their use of surveillance guidelines for colorectal cancer. Tension between both groups of medical professionals was apparent with regard to referral practices, with specialists advocating a rational approach to risk. However, the socio-cultural context within which General Practitioners' clinical decision-making takes place demands a more reflexive process. This paper argues the need to explore power within medical practice as the devolution of power to one group, specialists, who are constructed as the knowledge ‘elite’, sidelines other groups, in this case General Practitioners, who have to deal with the more qualitative aspects of health service delivery.

Keywords:

• risk
• evidence-based medicine
• surveillance guidelines
• clinical decision-making
• General Practitioners
• specialists
• medical specialisation

Acknowledgements

We would like to acknowledge the Health Research Council of New Zealand for funding this study. We also acknowledge all the other investigators in the larger project, the interviewers Anne Delwynen, Josie Toop, Virginia Hogg and Tami Cave, and the participants who gave generously of their time. Both authors contributed equally to this paper.