Implementing the evidence
Sarah Taylor explains why what works is not always what's done
For a long time there has been ample evidence that variable standards of practice fail significant numbers of patients. Furthermore, even dramatically positive results from rigorous clinical studies can remain largely unapplied.1 However, we live in a world where there is increasing political and patient pressure to show the effectiveness of what we do as doctors, and standardising clinical practice is becoming everybody's business. We might agree that the practice of medicine is not reducible to a mechanistic, fault free system, however, health professionals owe it to patients to apply the most effective practice.
With the emergence of clinical governance, 2 there are now systems in place to govern the quality of care. In reality this generates an industry for the development of clinical guidelines and protocols, and concern to measure the extent to which practice follows these standardised pathways.
Cochrane's promotion of randomised controlled trials (RCTs) made the science