Some limits to evidence-based medicine: a case study from elective orthopaedics

There has been growing interest in recent years in the application of the p rinciples of evidence-based medicine (EBM), although implementation is comp lex. Scientific, organisational, and behavioural factors all combine to sha pe clinical behaviour change. Case study based qualitative data are present ed which illuminate such processes within one clinical setting (elective or thopaedics), drawn from a larger study. It is suggested that (1) there are alternative models of what constitutes "evidence" in use; (2) scientific kn owledge is in part socially constructed; and (3) clinical professionals ret ain a monopoly of technical knowledge. The implication is that there may be severe obstacles, to the rapid or broad implementation of EBM.