Clinical guidelines and the fate of medical autonomy in Ontario.
Conceptually, clinical guidelines and professional autonomy have a paradoxical relationship.
Despite being the quintessence of medical knowledge at the corporate level, guidelines diminish the clinical autonomy of individual practitioners, and therefore threaten medicine's justification for its autonomy.
Theorists have argued that professional autonomy will be retained through elite dominance of practitioners, while comparative research suggests that economic autonomy can be traded off to retain clinical autonomy.
Under government pressure to regulate the growth of Ontario physicians'fee-for-service public expenditure, the profession's representative organization, the Ontario Medical Association (OMA), promoted voluntary clinical guidelines, hoping to both constrain costs and preserve professional control over the content of medical care.
The OMA collaborated with the Ministry of Health in developing guidelines and establishing a provincial centre for health service research.
Ontario's practitioners disregarded the OMA's exhortations to implement clinical guidelines, suggesting that in the absence of external constraints, practitioners can subvert elite dominance. (...)
Mots-clés Pascal : Recommandation, Prise décision, Médecin, Personnel sanitaire, Homme, Autonomie, Pratique professionnelle, Ontario, Canada, Amérique du Nord, Amérique, Directive
Mots-clés Pascal anglais : Recommendation, Decision making, Physician, Health staff, Human, Autonomy, Professional practice, Ontario, Canada, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0246325
Code Inist : 002B30A05. Création : 11/06/1997.