Why are physicians not persuaded by scientific evidence? A grounded theory interview study

Area of Science:

• Ophthalmology
• Health Policy
• Medical Practice

Background:

• Japanese cataract treatment guidelines questioned the effectiveness of pirenoxine and glutathione eye drops, standard care in Japan.
• This challenged ophthalmologists and professional societies, prompting an investigation into practice changes.

Purpose of the Study:

• To explore physicians' understanding of scientific evidence in relation to cataract eye drops.
• To identify barriers to implementing evidence-based policies in clinical practice.

Main Methods:

• A qualitative study using grounded theory.
• Interviews with 35 ophthalmologists and 3 general practitioners regarding prescribing habits and perceptions of evidence.

Main Results:

• Most physicians prescribed eye drops due to patient requests, despite low perceived effectiveness.
• Physicians noted benefits like economic incentives and patient appreciation, outweighing effectiveness concerns.
• Factors like government approval, low side effect incidence, and cost encouraged continued prescription.

Conclusions:

• Physicians may provide treatments without expecting significant therapeutic benefit, as seen with cataract eye drops.
• Scientific evidence alone is insufficient to alter physician behavior; public acceptance and health policy support are crucial for evidence-based practice adoption.