Many of the best practices discovered in the research community are never implemented in practice. Why is this the case? One reason is that physicians are overloaded with information and it is costly to cull the literature for best practice information. This is especially true when best practices are not clearly identified or change over time.
However, there is another reason why physicians would ignore best practices research: money.
“If you’re a radiologist and work in a hospital complex that can offer targeted proton beams from a $100 million cyclotron to treat prostate cancer (there’s more than a half dozen already up and operating in the U.S.), are you really interested in a scientific study that definitively determines whether that, drug therapy or simply ‘watchful waiting’ is the best course for treating that slow-growing tumor?”
The answer is ‘no’. In the UK, National Institute for Health and Clinical Excellence (NICE) uses comparative effectiveness research to determine which treatments are covered by the public health insurance. In the U.S., Patient-Centered Outcomes Research Institute (PCORI) aims to do the same thing but without the ability to affect payment policy. Thus, PCORI is doomed to be a near useless body.
I also get the sense that physicians sometimes recall and, at least on the surface, understand the literature but put too much weight on their opinion and go with their “gut”.