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Table 5 Quotations: Conflicts and decision-making

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

"Oh, we have examples of that daily. For instance, the patient thinks he must have a PSA. The evidence is not clear that that's going to save his life. In fact, it may render him incontinent and impotent for something that may not have bothered him at all." FP05
"There's tons of examples [of conflicts] at the moment. What about mammography and breast self-exam? Patients are as confused as family doctors are. I think it shows that science can only take us part of the way." FP04
"With evidence-based medicine, you're looking at the methodology. You're seeing how closely a patient fits with the particular study and many times your specific situation does not fit exactly. Then you're using clinical insights, you're using patient preferences, you're using your own experience, you're using the practice patterns of your community... Certainly, I think it behooves one to be aware of what the evidence is, but that doesn't mean that even though there's good evidence available that that's going to be the best answer in your specific situation." FP12
"It's pretty common that it happens [conflicting evidence] and it's a very difficult challenge. For the most part, the patients are usually informed of a conflict and they often ask what my opinion is, which I think is very interesting because EBM is telling us not to have opinions about it, but yet the patients are actually wanting our opinions." FP09
"When you've worked the number of years I have, you go with something you're familiar with. If there's two medications and you're not sure, you tend to stick with what you are familiar with, whether there's good evidence or not, I'm afraid. I go with what I know and what I've practiced – you might call it intuition." FP10
"In those cases [conflicting evidence], it's hard to know what to believe sometimes, but you just evaluate the evidence that's there and wait for better evidence.... I often ask for advice, usually from family physicians. Then also, although I don't have a lot of experience, you're also looking at your own experience, which I know is not great evidence [laughs], it's anecdotal evidence, but it sometimes does play a part." FP11
"When you've got conflicting results from evidence-based medicine – you've got evidence saying one thing and evidence saying the exact opposite thing – you're going to have to use other bits of information or strategies to try to decide which way you're going to go." FP12
"I can see lots of conflict between the goals of a study and the goals in real life." FP06