The Moral Force of Guidelines
How Surgeons Use Evidence-Based Medicine to Curb Their Interventionism
Bibliographic Data
| ID | 4352301 |
|---|---|
| Authors | Clay Davis (0000-0002-3443-3512, Department of Sociology Northwestern University Evanston Illinois USA, corresponding author) |
| Year | 2025 |
| Volume | 47 |
| Issue | 8 |
| Pages | e70089-e70089 |
| Publication date | 2025-11-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Sociology of Health & Illness (JOURNAL) |
| Journal identifiers | ISSN: 0141-9889 • E-ISSN: 1467-9566 |
| Publisher | Wiley (PUBLISHER • GB) |
| DOI | 10.1111/1467-9566.70089 |
| PMID | 41027841 |
| OpenAlex | W4414682619 |
| Language | EN |
| References cited | 41 |
The epistemology of evidence-based medicine (EBM) is said to clash with the culture of surgery: EBM demands contemplation, whereas surgeons prize decisive, and even heroic, action. How, then, have surgeons come to embrace EBM? To answer this question, I analysed evidence-based clinical practice guidelines (CPGs) and interviewed 15 attending surgeons at an academic medical centre in the United States. I find that surgeons use EBM to reconcile their interventionism with the changing demands made by their peers, patients, and payers in three moments that take place before, during, and after surgery, respectively. The first moment occurs at professional conferences where surgeons interpret ambiguous evidence in favour of action, embedding their instincts into EBM. The second moment unfolds in the clinic, where surgeons use EBM to communicate probabilistic risks to patients who expect surgeons to operate. The third moment transpires during recovery, when surgeons deploy EBM to shift the responsibility for action to paraprofessionals in line with payers' goal of shortening patients' hospitalizations. These findings challenge the notion that EBM merely standardises healthcare, rationalises patients' decisions or disciplines practitioners. Instead, I argue that evidence-based CPGs are not only epistemic tools but moral ones that surgeons use to prompt, forestall and delegate action
Clinical practice guidelines implementation · Healthcare cost, quality, practices · Patient-Provider Communication in Healthcare
For the sake of the children
Morality in Organizations
Abductive Analysis
Beyond Caring
Evidence based medicine
Moral Classification and Social Policy
The Moral Background: An Inquiry into the History of Business Ethics
Bodies in Formation
Evidence‐based medicine in practice
Hospital Length of Stay … A Measure of What, Exactly
Evidence-Based Medicine and Medical Authority
Academic urban legends
Institutional Ecology, `Translations' and Boundary Objects
The Social Construction of Facts and Artefacts
Regulatory objectivity and the generation and management of evidence in medicine
Clinical autonomy, individual and collective
The problem of evidence-based medicine
First do no harm
Resisting Evidence
Evidence-Based Medicine, Clinical Uncertainty, and Learning to Doctor
Uncertain Expertise and the Limitations of Clinical Guidelines in Transgender Healthcare
The Study of Boundaries in the Social Sciences
Gender destinies
Formats of responsibility
Guidelines, professionals and the production of objectivity
| Citation velocity | historical |
|---|---|
| Highly cited | No |