Abstract
BackgroundIn 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines—internalised and collectively reinforced tacit guidelines—rather than consulting written clinical guidelines. We considered how the concept of mindlines has been taken forward since.MethodsWe searched databases from 2004 to 2014 for the term ‘mindline(s)’ and tracked all sources citing Gabbay and le May’s 2004 article. We read and re-read papers to gain familiarity and developed an interpretive analysis and taxonomy by drawing on the principles of meta-narrative systematic review.ResultsIn our synthesis of 340 papers, distinguished between authors who used mindlines purely in name (‘nominal’ view) sometimes dismissing them as a harmful phenomenon, and authors who appeared to have understood the term’s philosophical foundations. The latter took an ‘in-practice’ view (studying how mindlines emerge and spread in real-world settings), a ‘theoretical and philosophical’ view (extending theory) or a ‘solution focused’ view (exploring how to promote and support mindline development). We found that it is not just clinicians who develop mindlines: so do patients, in face-to-face and (potentially) online communities.Theoretical publications on mindlines have continued to challenge the rationalist assumptions of evidence-based medicine (EBM). Conventional EBM assumes a single, knowable reality and seeks to strip away context to generate universal predictive rules. In contrast, mindlines are predicated on a more fluid, embodied and intersubjective view of knowledge; they accommodate context and acknowledge multiple realities. When considering how knowledge spreads, the concept of mindlines requires us to go beyond the constraining notions of ‘dissemination’ and ‘translation’ to study tacit knowledge and the interactive human processes by which such knowledge is created, enacted and shared. Solution-focused publications described mindline-promoting initiatives such as relationship-building, collaborative learning and thought leadership.ConclusionsThe concept of mindlines challenges the naïve rationalist view of knowledge implicit in some EBM publications, but the term appears to have been misunderstood (and prematurely dismissed) by some authors. By further studying mindlines empirically and theoretically, there is potential to expand EBM’s conceptual toolkit to produce richer forms of ‘evidence-based’ knowledge. We outline a suggested research agenda for achieving this goal.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0229-x) contains supplementary material, which is available to authorized users.
Highlights
In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines— internalised and collectively reinforced tacit guidelines—rather than consulting written clinical guidelines
They preferred to rely on what they called ‘mindlines’, defined as ‘collectively reinforced, internalised tacit guidelines, which were informed by brief reading, but mainly by their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives and by other sources of largely tacit knowledge that built on their early training and their own and their colleagues’ experience’ [1]
We argue that to study mindlines to their full potential, we need to break out of the constraining notions of ‘dissemination’ and ‘translation’ and focus more on the embodied nature of tacit knowledge and the interactive processes of knowledge creation
Summary
In 2004, Gabbay and le May showed that clinicians generally base their decisions on mindlines— internalised and collectively reinforced tacit guidelines—rather than consulting written clinical guidelines. In an ethnographic study in UK general practice, they showed that clinicians only rarely accessed research findings, clinical guidelines and other types of formal knowledge directly. Rather, they preferred to rely on what they called ‘mindlines’, defined as ‘collectively reinforced, internalised tacit guidelines, which were informed by brief reading, but mainly by their interactions with each other and with opinion leaders, patients, and pharmaceutical representatives and by other sources of largely tacit knowledge that built on their early training and their own and their colleagues’ experience’ [1]. A somewhat smaller literature (reviewed below) aligned with Gabbay and le May’s positive finding—that doctors follow mindlines—and sought to characterise, explore and occasionally critique the concept of collectively embodied tacit knowledge and how it links to the goal of evidence-based practice
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