Clinical autonomy, individual and collective: the problem of changing doctors' behaviour

Soc Sci Med. 2002 Nov;55(10):1771-7. doi: 10.1016/s0277-9536(01)00309-4.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel*
  • Decision Support Systems, Clinical*
  • England
  • Evidence-Based Medicine*
  • Humans
  • Interviews as Topic
  • Patient-Centered Care
  • Physician-Patient Relations
  • Physicians, Family / psychology*
  • Primary Health Care / standards
  • Professional Autonomy*