Why general practitioners do not implement evidence: qualitative study.

Objectives: To explore the reasons why general practitioners do not always implement best evidence.

Design: Qualitative study using Balint-style groups.

Setting: Primary care.

Participants: 19 general practitioners.

Main outcome measures: Identifiable themes that indicate barriers to implementation.

Results: Six main themes were identified that affected the implementation process: the personal and professional experiences of the general practitioners; the patient-doctor relationship; a perceived tension between primary and secondary care; general practitioners' feelings about their patients and the evidence; and logistical problems. Doctors are aware that their choice of words with patients can affect patients' decisions and whether evidence is implemented.

Conclusions: General practitioner participants seem to act as a conduit within the consultation and regard clinical evidence as a square peg to fit in the round hole of the patient's life. The process of implementation is complex, fluid, and adaptive.