Response to ‘EBM and gut feelings’

Dear Sir

We thank Stolper and colleagues for their thoughtful considerations regarding our paper. With our questionnaire and focus groups, we tried to identify the barriers General Practitioner (GP) trainers experience when practising evidence based medicine (EBM) because (GP) trainers are not very consistent in using EBM in daily practice or are even dismissive of it (van Dijk et al. 2010). One of our findings was that they see EBM mostly as applying clinical evidence and that they do not associate the definition with their own experience and the patients’ preferences. Although our questionnaires did contain questions on knowledge and skills, we also included questions about the attitude towards EBM and the collaboration with their trainee, in which multiple statements focussed on the use and integration of clinical experience and patient preferences. We agree with the authors that understanding the definition of EBM alone does not help to promote EBP. It can in our experience, however, reduce resistance against the concept of EBM, as it clarifies EBM is not just about evidence.

The GP's gut feeling is, and we agree with Stolper et al. (2011), a very important and complex issue in GP practice. Their findings and descriptions are very interesting and of great significance when studying GP clinical practice and GP training. In a current study, we therefore aim to identify whether and how the full concept of EBM can be operationalised in daily clinical practice, to avoid focusing on evidence alone in future assessment and studies. This includes the non-analytical or unconscious processes, described by Stolper et al. as gut feeling.