[General practioners and medical guidelines: a sociological approach].

Background: While designed to help physicians in their account of the changing state of the art and of the evidence-based medicine, the situation of the medical guidelines seem to be critical: they need time, they are too complex, they deal with pathologies as if they were isolated from the whole context.

Methods: In the survey, 279 general practioners were asked to answer a scenario dealing with these difficulties.

Results: More than a half of the practitioners interviewed approve the increasing role of guidelines in medical practice and say they try to take them into account, but they also say they generally rely on their own medical experience to operate a selection among the impressive set of guidelines they receive. The more they agree with an evidence-based medicine, the more they tend to accept the guidelines as a necessary dimension of their art.

Conclusion: The inquiry leads to a contrasted opinion: on the one hand, it incites to ameliorate the whole guidelines making process (paying attention to let the bottom up informations penetrate the process), and on the other hand, to admit that the imperfect appropriation of these norms is the presently best way to match the "saintly models" of medicine with the unescapable "dirty work" of everyday practice (as in the "strength of weak ties" effect).