[General practioners and medical guidelines: a sociological approach]. / Médecins généralistes et recommandations médicales : une approche sociologique.

BACKGROUND: While designed to help physicians in their account of the changing state of the art and of the evidence-based medicine, the situation of the medical guidelines seem to be critical: they need time, they are too complex, they deal with pathologies as if they were isolated from the whole context. METHODS: In the survey, 279 general practioners were asked to answer a scenario dealing with these difficulties. RESULTS: More than a half of the practitioners interviewed approve the increasing role of guidelines in medical practice and say they try to take them into account, but they also say they generally rely on their own medical experience to operate a selection among the impressive set of guidelines they receive. The more they agree with an evidence-based medicine, the more they tend to accept the guidelines as a necessary dimension of their art. CONCLUSION: The inquiry leads to a contrasted opinion: on the one hand, it incites to ameliorate the whole guidelines making process (paying attention to let the bottom up informations penetrate the process), and on the other hand, to admit that the imperfect appropriation of these norms is the presently best way to match the "saintly models" of medicine with the unescapable "dirty work" of everyday practice (as in the "strength of weak ties" effect).

[Representations of clinical practice guidelines by general practitioners]. / Représentations des recommandations professionnelles par les médecins généralistes.

The objective of this study is to understand the representations of general practitioners in regards to clinical practice guidelines. Two general practitioners samples have been studied according to two analytical methods: the method of scenarios, sent by e-mail to doctors belonging to a network, and a round table gathering volunteers having answered the scenario and drawn lots. 279 answers were received from 252 men and 27 women (response rate of 80%); eleven doctors (4 women) participated in the round table. Results analysis shows that the credibility of the scenario is judged as very good. Only 39% of the referees estimated that practice guidelines are little useful. The ideal type of answers was established. Five themes appeared from the debate, the main two being the elaboration of the guidelines and the measured opposition between medicine applied to individuals and epidemiology. The majority of the physicians considered clinical guidelines as a trump card, at the same moment as a tool and as an instigation, but found them difficult to hold and asked for their improvement.