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The evolution of clinical policies
1Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Medical Care
|March 1, 1990
Summary
Clinical policies can improve patient outcomes but may be adopted without evidence, misused, or even harmful. Understanding their evolution and the social forces involved is key to their appropriate use.
Area of Science:
- Medical Policy
- Health Services Research
- Clinical Practice Guidelines
Background:
- Physicians rely on clinical policies for patient management.
- Some policies lack evidence of benefit, are overextended, or are known to be ineffective or harmful.
Purpose of the Study:
- To analyze the evolution of clinical policies.
- To identify characteristic errors in reasoning and research at each stage.
- To understand the role of social forces in policy adoption and misuse.
Main Methods:
- The study outlines four stages in the evolution of clinical policies: development, diffusion, domination, and disillusionment.
- It examines the interplay between scientific evidence and social influences.
Main Results:
- Social forces, rather than scientific merit, often drive the adoption and application of clinical policies.
- Errors in reasoning and research are common at each stage of policy evolution.
Conclusions:
- Improving patient outcomes requires addressing the social dynamics influencing clinical policy use and misuse.
- Enhanced research methodology and critical appraisal skills alone may be insufficient without considering social factors.