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Practice is usually hard to change. At workshops, I often get participants to list how many changes they have made in their clinical practice in the past 12 months. These can be changes of preferred treatments, using a new test, or stopping something. Most folk list only 2 or 3 changes and usually do not know the evidence behind these changes. One issue of Evidence-Based Medicine should then be able to dramatically improve the rate of change! But even when we are motivated, a change of practice can feel awkward. Take reducing antibiotics for respiratory tract infections—knowing doesn’t seem to change much. Several trials have showed that delayed prescribing is helpful in getting doctors and patients to change. But is that change sustained long term? Well, Chris Cates, a pioneer of delayed prescribing, gives an account of the long-term follow-up of changes in his own general practice. It seems not only did they change, but local practices adopted the change as well. Now if we can just do that with all of the 20 changes in every issue of Evidence-Based Medicine!
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