I read with great interest the article by Huang and Stafford1 on the increasing tendency of ambulatory care physicians to prescribe fluoroquinolones and nitrofurantoin to patients with urinary tract infections. The authors have argued that probably subspecialty culture and increasing pharmaceutical promotions are the 2 main reasons for such deviant behavior.
Recent studies from the United Kingdom have indicated that there maybe many additional reasons why physicians do not implement evidence-based therapies.2 A similar trend has been also reported in the Netherlands3 and Australia.4 In a qualitative analysis of physicians interviewed from the United Kingdom,2 6 themes were identified that affected the implementation of evidenced-based therapies. These included the personal and professional experiences of the physician, the patient-physician relationship, perceived tensions between primary care physicians and specialists, physicians' feelings about their patients and the evidence, words used by the physicians, and the logistics of general practice. Also, the perception that treatment should be patient specific and not "disease specific" could make certain physicians use their personal experience and incorporate patients' values in managing their clinical problems and deviate from guidelines. There is also a tendency to continue current treatment that the patient is accustomed to, rather than prescribe a new drug based on the best available evidence.2
Ghosh AK. Adherence to Evidence-Based Therapy: Some Practical Problems. Arch Intern Med. 2002;162(11):1310-1311. doi: