| Titre : | Clinical autonomy, individual and collective : the problem of changing doctors'behaviour. (2002) |
| Auteurs : | ARMSTRONG (David) : GBR. Gkt Department of General Practice and Primary Care. King's College London. London. |
| Type de document : | Article |
| Dans : | Social science and medicine (vol. 55, n° 10, 2002) |
| Pagination : | 1771-1777 |
| Langues: | Anglais |
| Mots-clés : | Relation médecin malade ; Médecin ; Autonomie ; Malade ; Evaluation ; Homme ; Profession santé |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 0R0xg3il. Diffusion soumise ... autorisation]. Evidence-based medicine enables the profession to resist at least some of the challenges to its traditional autonomy : if informed doctors provide what is scientifically proven to be the best care there is less justification for external constraints. Yet, this defensive strategy depends on enforcing a new discipline within the profession such that individual practitioners accept mechanisms of external'decision support'in their clinical practice. A study of the ways in which general practitioners in British Primary Care change their clinical behaviour shows that an emphasis on a'patient centred'approach establishes an alternative individualised autonomy that seems inimical to the logic of evidence-based medicine. A tension therefore emerges between the maintenance of the autonomy of the profession as a collectivity through the promotion of a therapeutic rationality and the maintenance of the autonomy of the individual practitioner through the rhetoric of patient-centredness. |
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