What has trust got to do with it? Cardiac risk reduction and family physicians' discussions of evidence-based recommendations |
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| Authors: | Lois Jackson Wayne Putnam Peter Twohig Frederick Burge Kelly Nicol Jafna Cox |
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| Affiliation: | 1. School of Health and Human Performance , Dalhousie University , Canada;2. Department of Family Medicine , Dalhousie University , Canada;3. Gorsebrook Research Institute , Saint Mary's University , Canada;4. Departments of Medicine (Division of Cardiology) and Community Health and Epidemiology , Dalhousie University , Canada |
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| Abstract: | The management of patients through the use of evidence-based medicine has become the 'mantra' of medicine within many Western countries. Evidence-based medicine is aimed at providing the best objective, scientific care to all patients, and reducing as far as possible patients' risks of disease and complications from disease. Based on family physicians' discussions of the use of evidence-based recommendations for two cardiac diseases, this paper explores how subjectively-based trust enters into family physicians' decision to use evidence-based medicine. In addition, we show how trust influences physicians' work of recommending evidence-based medicine to patients, and physicians' perceptions of why patients follow recommendations aimed at risk reduction. We conclude that although much of the current discussion about evidence-based medicine assumes a 'rational' model of physician behaviour based on the application of the 'best objective scientific' results, subjectively-based perceptions of trust influence physician practices, and point to the need to understand the power of relational issues in influencing physician practices even when utilizing evidence-based knowledge. |
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| Keywords: | Risk Reduction Evidence-based Medicine Trust |
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