DO WE PRACTICE WHAT WE PREACH?

Abstract

Good medical practice predicates a contemporary knowledge of the literature to guide ones practice. The British edition of the Journal of Bone and Joint Surgery [JBJS (Br)] is considered one of the leading peer reviewed journals, guiding orthopaedic practice in the UK and abroad. Whilst seeking guidance on proposed changes to departmental policy, informal discussion with some high profile units raised concerns regarding the implementation of their published clinical recommendations. We intended to contact the publishing departments, to establish their routine practice with respect to the topic on which they have written in the literature.

We reviewed all articles published in JBJS (Br) over a 24 month period. Specifically we were seeking papers making recommendations for a change in practice. The originating department was contacted by telephone and communication sought from an individual not directly involved in the publication, but whom the change in practice stated in the literature would have direct impact.

Seventy-nine papers representing the work of 87 separate hospitals from 22 different countries were identified as making recommendations in any aspect of practice. We found that published articles were being followed in 56% of cases, 42% were not.

Our study demonstrates that a large proportion of institutions making clinical recommendations are not practicing them. Should the author’s own institution not follow their guidance, then how can the wider orthopaedic community be expected to follow? As such, have we exposed a fundamental flaw in the publication of clinical research?

In conclusion, we do practice what we preach… sometimes.