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Table 2 Quotations: Benefits and barriers

From: Evidence-based medicine in primary care: qualitative study of family physicians

"Throughout my residency, EBM was certainly spoken of a great deal ... and I was quite an advocate, but it has been tough to put it into practice in the real world. So maybe it was a little over-touted or maybe it's just growing pains, I'm not sure which, but it's still early days. I think that it's still too early to write it off; I still have hopes for it myself. I think it's philosophically the way to go, but the tools for putting it into practice have yet to be adequately developed." FP01
"I don't think you sell out all your other methods for evidence-based medicine. You can't just practice exclusively evidence-based medicine, or else you'll miss out on some things. Having said that, however, I do support more use of it, especially for the initial management of common problems... It's very useful to have an evidence-based structure because you often have undifferentiated presentation at the outset. As you follow the course of an illness, then you have more individual solutions." FP12
"It's a buzzword. Maybe they used a different word before. We always had to have evidence that things work before you put them in practice, right? You never did something unless you had evidence. In the '70s, I always looked at what evidence there was from clinical trials and clinical practice guidelines before I implemented." FP14
"For family medicine, I think that we now have something to base our approaches on rather than just sort of general nice feelings. We have a more organized way, particularly from a teaching point of view, of how to approach problems.... I think [EBM] is probably the only way to go now, given that we have access to such a mountain of information." FP10
"Evidence-based medicine seems to be a word that has become very fashionable, and in many ways, I wonder how it is different than the medicine that I learned 30 years ago. To me, it means that there is evidence to show that something is effective and I thought that that's what we did all along... I haven't seen anything in it that convinces me that it's a huge paradigm shift." FP06
"I think it's really important. I try to be evidence-based as much as I can ... and I try to stay up to date. I try to explain things to patients, because they don't always understand, particularly if I'm doing something that they don't expect. Then I'll try to explain to them that there's evidence for doing or not doing something." FP11
"I think it's good, because it actually protects us. If we're ever accused or criticized for the practice that we're performing and we can go back to the studies and say, 'Here's the evidence that suggests this is the best way to treat it.' That protects you from a medical/legal point of view and it also allows you to reassure the patient that the practice you're pursuing is based on evidence that's been gleaned by good quality studies." FP08
"I think it [EBM] needs distillation. It's difficult to apply in family practice because there are a gazillion guidelines out there, all purporting to be based on the evidence." FP05
"I think EBM is predicated upon there being well-supported and financed independent reviewers who are doing the meta-analyses and the broader views which have become the key to evidence-based medicine and then selecting which ones are quality enough to include. It's just not practical for the family practitioner to be able to do that, even if you do have the tools, the time just isn't going to be there." FP01
"One problem is when we take on some EBM evidence, our patients may not fit into the sample that was studied. Part of the challenge I have is trying to remember who was in the studies and who it applies to. You know, I'm not going to go look up every single study every time I want to apply some of the literature to my patients. I think that's definitely a factor." FP09
"I think for the average practitioner, EBM has limited applicability or practicality in its current format. It has to be changed if it's going to be practical for use by most family doctors." FP02
"I think that you still have to consider expert opinion, because you have to rely on the experts to evaluate what the literature shows, to give you some kind of impression overall, like how applicable it is to other people. I don't think that the individual standardly trained physician that's working in the community has the time or training or interest to decide what's good evidence and what isn't. So I think you still need the experts." FP09
"A lot of times the findings of these large clinical trials are indiscriminately applied to a population that it doesn't apply to. I'm very critical of that. I'm sort of on hyper-alert for not doing that.... I wouldn't want to be treated exactly the same way as 10 million other people simply because for 90 percent of people this works. What if I'm one of the other 10 percent?" FP06
"It's difficult to adopt evidence-based medicine in primary care when every patient needs to have every investigation that you think is appropriate. So, I'm always making judgments and yet trying to keep in mind the fact that there are some things I shouldn't do because the evidence isn't there for it." FP03
"It's very difficult right now because the resources are poor and the funding for family physicians is targetted towards solving problems rather than practicing evidence-based medicine. We are paid to put out fires, if I might say so. We don't get enough time to practice evidence-based medicine in terms of prevention." FP14
"I do not offer colon cancer screening to my patients, for instance. The evidence is there that it helps, but I don't have the time to go through it and we don't have the colonoscopy backup – it just isn't available here." FP05