A Doctor's Order : The Dutch Case of Evidence-Based Medicine (1970-2015)
In the early 1990s, a new concept was coined: ‘evidence-based medicine’ (EBM). After a remarkably short time, EBM was virtually all-pervasive in medicine and healthcare throughout the world – with the Netherlands at the forefront. How should we understand this new phenomenon? And: what actually is evidence-based medicine? These questions are all the more relevant because, on reflection, EBM proves to be an elusive, multifaceted entity. Various stakeholders sometimes give widely differing meanings to it, and EBM itself has undergone a number of substantial changes over the course of time. It is... Mehr ...
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Dokumenttyp: | Dissertation |
Erscheinungsdatum: | 2015 |
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Garant
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Schlagwörter: | evidence-based medicine / history / healthcare policy / the Netherlands |
Sprache: | Englisch |
Permalink: | https://search.fid-benelux.de/Record/base-27610386 |
Datenquelle: | BASE; Originalkatalog |
Powered By: | BASE |
Link(s) : | https://dspace.library.uu.nl/handle/1874/318971 |
In the early 1990s, a new concept was coined: ‘evidence-based medicine’ (EBM). After a remarkably short time, EBM was virtually all-pervasive in medicine and healthcare throughout the world – with the Netherlands at the forefront. How should we understand this new phenomenon? And: what actually is evidence-based medicine? These questions are all the more relevant because, on reflection, EBM proves to be an elusive, multifaceted entity. Various stakeholders sometimes give widely differing meanings to it, and EBM itself has undergone a number of substantial changes over the course of time. It is therefore the objective of this study to arrive at an answer to the aforementioned questions from a historical perspective. From its history it appears that the phenomenon of EBM maybe characterised as ‘A Doctor’s Order’ – the title of this dissertation, which refers to two essential aspects of evidence-based medicine. The first aspect is contained in the title word ‘order’, which refers to EBM as a mechanism of control – an instrument for ‘ordering’ (regulating, formalising, rationalising, standardising) medical practice. The rise of EBM in medicine and healthcare is often analysed (referring to the work of Theodore Porter) as a professional response to external societal pressure. The argument runs as follows: when public distrust towards medicine grew, the field was in need of an instrument which would guarantee transparency and accountability – and hence trust. This places the rise of EBM keenly in the context of the late twentieth century, when, indeed, medicine faced increasing pressures, as a result of the burgeoning costs of the welfare state necessitating cutbacks, criticisms of ‘medicalisation’, and the increasing uncertainty of physicians who were confronted with an ever more complex practice and an unmanageable explosion of medical knowledge. Yet, Porter’s interpretive framework is too instrumental and anonymous to satisfyingly characterize EBM. In the description of the ‘Dutch Case of EBM’ it emerges clearly ...