Intended for healthcare professionals

Rapid response to:

Primary Care

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

BMJ 2004; 329 doi: (Published 28 October 2004) Cite this as: BMJ 2004;329:1013

Rapid Response:

As this article passes its 10th birthday, we have been gratified at the extent to which it has been quoted in the literature (approaching 500 citations according to Google Scholar) and even more so by the way in which its ideas - particularly our concept of clinical mindlines - have been entering into the discourse about the implementation of evidence-based practice across a range of health professions. However we would point out that this article represented a very early stage in our thinking about this topic, and was necessarily limited in its scope. Whilst we recognise that modern bibliographic search methods will always tend to take researchers to journal articles rather than books - and that articles are much quicker to read! - we hope that those who are interested in pursuing the topic will also consider delving into the kind of detail that books, rather than short articles such as this, can bring to one's understanding of such complex matters.

Our subsequent book on this topic (1), which was published 7 years after this paper and was based on considerable additional fieldwork within this ethnography and other supplementary ones that we designed to better elucidate the emerging findings, corroborates the results and conclusions set out in this article. But it takes them a great deal further. In particular, we explore much more deeply the significance of our findings for the promulgation and use of clinical guidelines ; the educational implications of the ways in which mindlines are developed and used over a clinician's career; the concept of what we call 'knowledge-in-practice-in-context' as opposed to the simple knowledge in practice discussed in the article; the suggestion of 'contextual adroitness' as a refinement of current theories of expertise; the role of storytelling and narrative in the growth and transmission of mindlines; and the role of communities of practice, 'actor networks' and other peer groupings in developing both individual and collective mindlines. We link these and other findings to a range of social, organisational, educational and philosophical theories that help shed light on their significance. We also consider in some detail the implications of our findings for clinical practice, for clinical education and for the conduct, dissemination and implementation of health research among policymakers, practitioners, managers and patients.

Although, 10 years on, this letter hardly counts as a ‘rapid response’, we felt it worthwhile to point out this further source in case readers who are interested in following up the ideas raised in this article were unaware of it.

1 Gabbay J le May A: (2011) Practice-based evidence for healthcare: Clinical mindlines. London: Routledge

Competing interests: We are the authors of this article and the book to which we refer here

03 October 2014
John Gabbay
Emeritus Professor
Andree le May
Wessex Institute of Health Research and Development and Faculty of Health Sciences, University of Southampton
Lymington, SO41 3PQ