Trépos J-Y, Laure P
Erase, laboratoire lorrain de sciences sociales, université Paul-Verlaine-Metz, Ile du Saulcy, B.P. 30309, 57006 Metz cedex 1, France.
Rev Epidemiol Sante Publique. 2008 Jul;56 Suppl 3:S221-9. doi: 10.1016/j.respe.2008.04.007. Epub 2008 Jun 6.
While designed to help physicians in their account of the changing state of the art and of the evidence-based medicine, the situation of the medical guidelines seem to be critical: they need time, they are too complex, they deal with pathologies as if they were isolated from the whole context.
In the survey, 279 general practioners were asked to answer a scenario dealing with these difficulties.
More than a half of the practitioners interviewed approve the increasing role of guidelines in medical practice and say they try to take them into account, but they also say they generally rely on their own medical experience to operate a selection among the impressive set of guidelines they receive. The more they agree with an evidence-based medicine, the more they tend to accept the guidelines as a necessary dimension of their art.
The inquiry leads to a contrasted opinion: on the one hand, it incites to ameliorate the whole guidelines making process (paying attention to let the bottom up informations penetrate the process), and on the other hand, to admit that the imperfect appropriation of these norms is the presently best way to match the "saintly models" of medicine with the unescapable "dirty work" of everyday practice (as in the "strength of weak ties" effect).
虽然医学指南旨在帮助医生了解不断变化的技术水平和循证医学情况，但其现状似乎很严峻：它们需要时间，过于复杂，处理病症时仿佛将其与整体背景割裂开来。
在此次调查中，279名全科医生被要求回答一个涉及这些难题的情景问题。
超过半数接受访谈的医生认可指南在医疗实践中日益重要的作用，并表示他们试图予以考虑，但他们也表示，在收到的大量指南中进行筛选时，通常还是依靠自身的医疗经验。他们越认同循证医学，就越倾向于将指南视为其医术的必要组成部分。
该调查得出了一种矛盾的观点：一方面，它促使改进整个指南制定过程（注意让自下而上的信息融入该过程），另一方面，要承认目前对这些规范的不完美应用是使医学的“完美模式”与日常实践中不可避免的“繁杂工作”相匹配的最佳方式（如同“弱关系的力量”效应）。
