Indeterminacy and technicality revisited: how medicine and nursing have responded to the evidence based movement

In 1970 sociologists Jamous and Peloille proposed that occupational work could be understood as a combination of technical activity and indeterminate judgement and that the professions were characterised by high levels of indeterminacy relative to technicality. They argued that groups with low status or on the fringes of powerful professional groups were more likely to promote technically based reform, whereas elites were likely to resist with assertions of indeterminacy. Subsequent writers claimed that their notion of the indeterminacy/technicality ratio was more useful in analysis of professional ideology than in examinations of work content. During the 1990s the evidence based movement exerted a strong influence within the healthcare professions. Medicine and nursing responded in ways that reflected their differing status; however, both reactions included assertions that evidence based practice (EBP) could not take into account the subtle expertise required in daily clinical decision making. This paper argues that Jamous and Peloille's theories about technical reform and professional elites can help to explain responses to EBP. EBP was initially promoted by a relatively low-status speciality of medicine while nursing, as an emerging profession, has shown more enthusiasm for its activities being formalised in a technically based fashion.