Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle.

{"article_title":"Paradoxes of Practice Guidelines, Professional Expertise, and Patient Centeredness: The Medical Care Triangle.","author":"Issel LM","journal_title":"Medical care research and review : MCRR","issn":"1552-6801","isbn":"","publication_date":"2019 Aug","volume":"76","issue":"4","first_page":"359","page_count":"","accession_number":"29745304","doi":"10.1177\/1077558718774905","publisher":"Sage Periodicals Press","doctype":"Journal Article","subjects":"Clinical Competence standards; Delivery of Health Care; Guidelines as Topic standards; Patient-Centered Care; Evidence-Based Practice; Humans","interest_area":["Internal\/Family Medicine"],"abstract":"The coexistence of institutionalized evidence-based practice guidelines, professional expertise of medical practitioners, and the patient centeredness approach form a triangle. Each component of this Medical Care Triangle has characteristics that create paradoxes for health care professionals and their patients. The value of a paradox lies in uncovering and utilizing the contradiction to better understand the underlying organizational phenomenon. Method: Following Poole and van de Ven's (1989) suggested approaches to resolving paradoxes, each paradox of the Medical Care Triangle is defined and analyzed. Results: A total of 10 paradoxes related to practice guidelines, professional expertise, and patient centeredness are revealed. The resolution of each paradox yields insights specific to structuring health care organizations in ways that support the delivery of medical care. Implications: The results renew an emphasis on the centrality of practitioners' work processes to health care organizations; this has potential benefits for organizations, clinicians\/employees, and patients.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=29745304&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Issel LM","Journal_Info":"Publisher: Sage Periodicals Press Country of Publication: United States NLM ID: 9506850 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6801 (Electronic) Linking ISSN: 10775587 NLM ISO Abbreviation: Med Care Res Rev Subsets: MEDLINE","Publication_Type":"Journal Article; Review","Published_Date":"2019-08-01","Source":"Medical care research and review : MCRR [Med Care Res Rev] 2019 Aug; Vol. 76 (4), pp. 359-385. Date of Electronic Publication: 2018 May 10.","Languages":"English","Electronic_ISSN":"1552-6801","MeSH_Terms":"Delivery of Health Care* , Patient-Centered Care*, Clinical Competence\/*standards , Guidelines as Topic\/*standards, Evidence-Based Practice ; Humans","Subjects":"Evidence-Based Practice, Humans, Clinical Competence standards, Delivery of Health Care, Guidelines as Topic standards, Patient-Centered Care","Title_Abbreviations":"Medical care research and review : MCRR","Volume":"76"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"29745304","RelevancyScore":"836","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"836.11669921875"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=29745304&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=29745304&authtype=shib&custid=ns346513&group=main&profile=eds"}