Handling uncertainty: Standard and local practices in the case of libido and contraception in evidence-based decision-making

Abstract

This paper draws from a qualitative study of interviews with 14 health practitioners to explore the use of reproductive health guidelines in contraception consultations. An aim of standardised guidelines is to encourage health practitioners to use scientific evidence in clinical decision-making. The paper uses health practitioners’ management of decreased libido as a case study to highlight the paradox of evidence-based medicine when the evidence and guidelines do not match clinical presentations and practice. This case study also illustrates how the tension between guidelines and clients’ needs are managed in the clinical encounter. The paper suggests that an interactionist approach, which emphasises the interrelationship between guidelines and health practitioners’ clinical work, is an alternative to standardisation for handling uncertainties in clinical practice.