Intended for healthcare professionals

Primary Care

Why general practitioners do not implement evidence: qualitative study

BMJ 2001; 323 doi: (Published 10 November 2001) Cite this as: BMJ 2001;323:1100
  1. A C Freeman, general practice research facilitator (PCRN{at},
  2. K Sweeney, general practice research facilitator
  1. Somerset and North and East Devon Primary Care Research Network, Institute of General Practice, School of Postgraduate Medicine and Health Sciences, Exeter EX2 5DW
  1. Correspondence to: A C Freeman
  • Accepted 6 August 2001


Objectives: To explore the reasons why general practitioners do not always implement best evidence.

Design: Qualitative study using Balint-style groups.

Setting: Primary care.

Participants: 19 general practitioners.

Main outcome measures: Identifiable themes that indicate barriers to implementation.

Results: Six main themes were identified that affected the implementation process: the personal and professional experiences of the general practitioners; the patient-doctor relationship; a perceived tension between primary and secondary care; general practitioners' feelings about their patients and the evidence; and logistical problems. Doctors are aware that their choice of words with patients can affect patients' decisions and whether evidence is implemented.

Conclusions: General practitioner participants seem to act as a conduit within the consultation and regard clinical evidence as a square peg to fit in the round hole of the patient's life. The process of implementation is complex, fluid, and adaptive.

What is already known on this topic

What is already known on this topic General practitioners do not always act on evidence in clinical practice

General practitioners are reluctant to jeopardise their relationship with the patient and sometimes feel that patients are unwilling to take drugs

What this study adds

What this study adds Implementation of evidence by general practitioners is a complex and fluid process

Decisions are influenced by the doctor's personal and professional experience as well as by their knowledge of and relationship with the patient

Doctors' choice of words can influence patients' decisions about treatment


  • Funding This research was supported by a grant from the NHS South West Research and Development Executive.

  • Competing interests None declared.

  • Accepted 6 August 2001
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