The Impossible Clinic
A Critical Sociology of Evidence-Based Medicine
Evidence-based medicine (EBM) has failed. Once considered revolutionary, it has facilitated cookbook medicine that undercuts physicians’ critical appraisal in individual decisions while increasing their responsibility for the improvement of health care.
The Impossible Clinic traces the emergence of, and problems inherent in, EBM – an approach that requires doctors to integrate research evidence into their clinical decision making. EBM attempts to translate the results of medical research into recommendations for practice, to bring science straight to the bedside with the goals of medical standardization. Ironically, however, when disciplinary regulation converges with EBM to produce systematic clinical practice guidelines, the outcome is antithetical to the aim. Ariane Hanemaayer uses a critical sociology approach to uncover the power relations underlying the contemporary organization of the medical profession, arguing that EBM persists because it has congealed within the dominant liberal political strategy of governance, which seeks to improve health care “at a distance,” at the least cost, and without investment in infrastructure.
As such, The Impossible Clinic is the first book to interrogate the history, practice, and pitfalls of EBM and how it persists due to intersecting relationships between professional medical regulation and liberal governance strategies. This persuasive indictment is essential reading.
This book offers compelling insights into the medical profession for scholars of critical sociology and the sociology of medicine and health. Those interested in the sociology of regulation, the history of medicine, social theory, and the health professions will also find it to be of interest.
This is an exemplary, scholarly study of the conceptual, practical, and institutional rules of formation of evidence-based medicine. This book has relevance not just for the Canadian context, of which it provides a scrupulous analysis, but for trends in clinical medicine globally.
Through a skilful application of Foucault’s historical studies of medical knowledge, disciplinary power, and liberal governance to the case of Canadian health care, Hanemaayer convincingly shows how ‘evidence-basedʼ professional codes of conduct shift responsibility away from individual physicians and institutionalize new forms of social control.
1 Conversations in Medicine: Problematizing Clinical Practice
2 Institutional Sites: McMaster University and Canada’s Contribution to Medical Training
3 Responsibilizing a New Kind of Clinician: Problem-Based Learning
4 Technologies of Regulation: Clinical Practice Guidelines and the Effects of Normalization
5 The Impossible Clinic: Biopolitics, Governmentality, Liberalism
Notes; References; Index
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