006 The barriers to evidence-based diagnostic methods change over time

<h3>Background</h3> Medical education may act as a driver of over-diagnosis. The aim of the two case studies compared here was to increase understanding of attempts to introduce a more scientific approach to diagnosis and treatment at the school of medicine at Trinity College Dublin in the nineteenth and also in the early twentieth century. <h3>Research Methods</h3> Employing a social-history methodology, primary manuscripts, older books, contemporary journal articles and newspapers were accessed through The Manuscripts and Archives Research Library of Trinity College Dublin The Early Printed Books Department of Trinity College Dublin The Library of the Royal College of Physicians in Ireland The Rockefeller Foundation Archive, New York Electronic databases, including the Lind Library, The Cochrane Library, and Embase, among others. <h3>Findings</h3> In the nineteenth century there was a resistance to a concept of medicine that was no longer based on classical Greek or Latin texts. There was a dislike of the increasing emphasis on anatomical dissection and systematic bedside examination. Polite learning, rather than professional knowledge, was pivotal. Gentlemanly behaviour, not diagnostic ability, was preferred. Manual examination of the patient in order to assist accurate diagnosis was not considered ‘gentlemanly’. It was regarded as tradesman-like. In the early twentieth century attempts were made to incorporate laboratory techniques into medical teaching, in order to produce laboratory-trained teachers and researchers. However Dublin, like Edinburgh, turned out all-round medical men suited to the practical needs of the British navy and the colonies. Medical education was dominated by practitioners. There was a resistance to the introduction of a more scientific orientation towards diagnosis. This was due to an emphasis on the production of able general practitioners, well-suited to the harsh conditions prevailing overseas. Research-orientated, investigative scholars were not encouraged. A systematic, laboratory-based model of clinical diagnosis, promoted through the integration of university academic departments and their associated teaching hospitals, encountered resistance. The newly-qualified doctor was not imbued with a lasting conviction that he must remain an investigator and a student to the end of his professional career. An intuitive, practitioner approach was preferred. <h3>Conclusion</h3> Entrenched resistance to a more scientific recasting of diagnostic methods is described in the international literature. In the nineteenth century, the maintenance of prestige and social position played a decisive role in the resistance to change. In the twentieth century however, raising diagnostic methods to university standards also proved difficult. It was a challenge to introduce academic goals and criteria into both voluntary and work-house hospitals. There were obstacles to turning these clinical settings into university teaching hospitals, with research central to all activities in the curing of the sick. The two case studies compared here, addressing different time periods, confirmed that the barriers to evidence-based diagnostic methods altered significantly between 1815 and 1935. Change in medical education and practice, when it came, had to overcome quite different barriers at different times. The significant obstacles to evidence-based diagnosis are not static. The barriers change over time.