BMJ  2005;330:93 (8 January), doi:10.1136/bmj.330.7482.93

Letter

Evidence based medicine: does it make a difference?

In Germany disease is treated via patients' clinical pictures rather than by following mindlines

The first 150 words of the full text of this article appear below.

EDITOR—Gabbay and le May put into focus the processes of "collective sense making" by which knowledge, both explicit and tacit and from whatever sources, is negotiated, constructed, and internalised in routine practice.¹ They identified mindlines replacing guidelines in daily practice. If these processes of collective sense making are assumed to be shaped by, among other factors, culture and training, I wonder whether the social construct of mindlines is also a valid approximation for other countries.

For Germany I think that a similar study would reveal neither mindlines nor other linear structures. Instead of the linear, algorithm driven process commonly used in Anglo-Saxon practice, in Germany the process of diagnosis might better be described as adjusting memorised disease patterns to the clinical pictures of patients. The experience of a doctor is reflected by an increased number of actively retrievable disease patterns. The linguistic equivalent would be the term Krankheitsbild. . . [Full text of this article]

Department of Epidemiology, Social Medicine, and Health System Research, Hanover Medical School, D-30623 Hanover, Germany Gerhardus.ansgar@mh-hannover.de

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Evidence based guidelines or collectively constructed "mindlines?" Ethnographic study of knowledge management in primary care

John Gabbay and Andrée le May
BMJ 2004 329: 1013. [Abstract] [Full Text] [PDF]

Online poll

Find out more >>