The Impossible Clinic

The aims of evidence-based medicine cannot be reconciled with its outcomes, yet this impossible practice persists at the intersection of professional medical regulation and liberal governance strategies.

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Once considered revolutionary, evidence-based medicine (EBM) has failed. The Impossible Clinic explores the conundrum of EBM’s attempt to translate evidence from medical research into recommendations for practice. Ironically, when medical institutions combine disciplinary regulations with EBM to produce clinical practice guidelines, the outcomes are antithetical to the aim. Such guidelines fail to increase individual physicians’ decision-making capacities – as EBM promises – because they externalize judgment through disciplinary control. Ariane Hanemaayer uses a critical sociology approach to argue that EBM persists because it has congealed within the dominant liberal political strategy of governance, which seeks to improve health care “at a distance,” at the least cost, and without investment in infrastructure. As such, The Impossible Clinic is the first book to interrogate the history, practice, and pitfalls of EBM and explain how it persists due to intersecting relationships between professional medical regulation and liberal governance strategies.