Why general practitioners do not implement evidence: qualitative study

Objectives To explore the reasons why general practitioners do not always i mplement 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 impleme ntation. Results Six main themes were identified that affected the implementation pr ocess: the personal and professional experiences of the general practitione rs; the patient-doctor relationship; a perceived tension between primary an d 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 with in 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 comp lex, fluid, and adaptive.