This book details scientific, cultural, and practical limitations posed to medical practice by the field of outcomes research. It examines why physicians (and patients) ignore and, in some cases, resist such research. The intent is presumably to change the way doctors practice by having them employ information gleaned from outcomes data. In reality, the book provides useful understanding of the field but offers little in the way of practical advice. It is aimed primarily at medical ethicists who interact with practicing physicians. It is also useful to those in healthcare policy interested in outcomes research, practice guidelines, and technology assessment. While few of the contributors are practicing specialists familiar with the technical limitations of outcomes data, they handle the analysis well. The first section discusses moral problems outcomes research poses. The second section describes specific projects in outcomes research and the related development of practice guidelines. The final section deals with value judgments inherent in outcomes research/technology assessment. Particularly strong is the chapter on four different agencies' attempts to convene consensus panels and develop practice guidelines. The editor does a good job highlighting unacknowledged shortcomings of the process. A major limitation is the occasional lapse into arcane sociopolitical jargon (e.g., "decontextualizing") when describing subtle value judgments of outcomes research. The basic theme is ancient: "What part of medicine is art and what part science?" Since most work done in outcomes research/technology assessment is recent (post-1990), few texts have examined its ethical implications, makingthis book groundbreaking. Unfortunately, the eighteen contributors make the book a choppy product that may not reflect the editor's original intent. Chapters containing duplicated discussions of practice guidelines would benefit from more complete editing. Few readers will want to read this book cover-to-cover, but ethicists, researchers, and clinicians may find specific chapters invaluable references.
Getting Doctors to Listen has one of the hallmarks of truly important scholarly work: implications beyond its stated scope.
Journal of the American Medical Association
Comprises 14 contributions exploring how the implementation of outcomes data and practice guidelines is prone to stalling due to resistance to the data by its physician-users. Chapter topics include an historical perspective on the origins and significance of clinical practice guidelines, technology assessment, clinical judgment versus outcomes research, communication and physician accountability, and a case study of practice guidelines regarding otitis media with effusion. Annotation c. by Book News, Inc., Portland, Or.
A probing and tightly-knit collection of papers . . . Getting Doctors to Listen has one of the hallmarks of truly important scholarly work: implications beyond its stated scope. In particular, the findings of the project pose a deep problem for the ethics of research.
JAMA (Journal of the American Medical Association)
Reviewer: Cory M. Franklin, MD (Cook County Hospital)Description: This book details scientific, cultural, and practical limitations posed to medical practice by the field of outcomes research. It examines why physicians (and patients) ignore and, in some cases, resist such research.Purpose: The intent is presumably to change the way doctors practice by having them employ information gleaned from outcomes data. In reality, the book provides useful understanding of the field but offers little in the way of practical advice.Audience: It is aimed primarily at medical ethicists who interact with practicing physicians. It is also useful to those in healthcare policy interested in outcomes research, practice guidelines, and technology assessment. While few of the contributors are practicing specialists familiar with the technical limitations of outcomes data, they handle the analysis well.Features: The first section discusses moral problems outcomes research poses. The second section describes specific projects in outcomes research and the related development of practice guidelines. The final section deals with value judgments inherent in outcomes research/technology assessment. Particularly strong is the chapter on four different agencies' attempts to convene consensus panels and develop practice guidelines. The editor does a good job highlighting unacknowledged shortcomings of the process. A major limitation is the occasional lapse into arcane sociopolitical jargon (e.g., "decontextualizing") when describing subtle value judgments of outcomes research.Assessment: The basic theme is ancient: "What part of medicine is art and what part science?" Since most work done in outcomes research/technology assessment is recent (post-1990), few texts have examined its ethical implications, making this book groundbreaking. Unfortunately, the eighteen contributors make the book a choppy product that may not reflect the editor's original intent. Chapters containing duplicated discussions of practice guidelines would benefit from more complete editing. Few readers will want to read this book cover-to-cover, but ethicists, researchers, and clinicians may find specific chapters invaluable references.
