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C. David Naylor, MD, DPhil

JAMA. 2004;291:104-106.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Better decision making by physicians could materially improve the balance of benefits and harms in health care while saving billions of dollars. It is therefore little wonder that academics, policy makers, third-party payers, and leaders of the profession alike have been grappling for many years with the challenge of modifying physician behaviors.

Conventional wisdom on that issue has arguably evolved through 4 phases.¹ The Era of Optimism featured a belief that physicians could be transformed into critical appraisal machines, tirelessly combing the peer-reviewed literature and consistently translating the best evidence about drugs and devices into action. The Era of Innocence Lost and Regained saw a loss of faith in passive diffusion of evidence and its distillation by individual clinicians. Instead, the medical establishment fervently embraced active dissemination and collective synthesis of evidence in the form of meta-analyses, decision analyses, and practice guidelines. The Era of . . . [Full Text of this Article]

Author Affiliation: Office of the Dean, Faculty of Medicine, University of Toronto, Toronto, Ontario.

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