Evidence-based healthcare in context: critical social science perspectives

Abstract

EVIDENCE-BASED HEALTHCARE IN CONTEXT: CRITICAL SOCIAL SCIENCE PERSPECTIVES Edited by Alex Broom and Jon Adams 2012, Ashgate ISBN: 9780754679813 10.1071/AHv36n3_BR3The notion of evidence-based healthcare is now so ubiquitous as to be largely unquestioned as a desirable part of the health landscape. After all, who would not want to have evidence-based care? As Broom and Adams state, evidence-based medicine is a 'seemingly benign concept', the complexity of which only emerges when consideration is given to what constitutes evidence, and what is included in, or excluded from, evidencebased frameworks. Broom and Adams have brought together a range of authors to present critical social science perspectives, thus providing a timely reminder that what may be viewed as scientific and objective is, in fact, part of health and care systems that are integrally embedded in social systems.Broom and Adams set the scene in their introduction in which they state that, 'Evidence-based paradigms now fundamentally shape the way health service providers, health funding bodies, governments and policy makers view 'effectiveness', and their willingness to fund and support interventions, practices, models of care and practitioners' (p. 3). The purpose of a critical social science perspective is to '...examine how the principles, technologies and practices of 'evidence based approaches' may allow certain things and promote certain understandings of health and illness while silencing others' (p. 3). There is a diverse array of fields in which notions of evidence-based have become integral to policy and funding decisions, all of which can highlight different aspects of the key debates. Following an introduction which provides an excellent overview of the key debates about evidence, the text is divided into three parts.Part one, 'Evidence in cultural and theoretical context', contains two chapters. The capacity for clinicians to understand, interpret and use evidence is at the heart of the chapter by Timmermans and Angell. In the context of uncertainty, what does evidence offer to new practitioners and how do they weigh it up against other sources of knowledge? Much research has been undertaken on how knowledge is learnt and exchanged in the clinical setting and this study points to different ways in which new practitioners use evidence. The second chapter in this section by Holmes and O'Byrne problematises the notion of evidence by drawing on theories that can help unpack ideologies about knowledge, power and stratification. Evidence-based medicine is critiqued for its dominance in knowledge construction. This chapter sits well within part one, providing a theoretical examination of evidence, but knowledge of social theory is needed to really grasp the arguments that are being made, and there needed to be a clearer fit with all other chapters (which are largely empirically-based).In part two 'Evidence in the clinic', three chapters highlighting different clinical settings are presented. Brattheim, Faxvaag and Tjora explore the nature of 'situational knowledge' using the example of aorta implant surgery to argue that attention to context and communal bases of expertise must be acknowledged to understand knowledge (and evidence) transfer. …