How The Light Gets In

A book that begins with a fragment of a Leonard Cohen song is unlikely to be all bad, and this one is pretty good. Published 3 years ago, it deserves rereading or reading for the first time by anyone with an interest in how research evidence gets into clinical practice — precisely the theme of this month’s BJGP. John Gabbay is a distinguished health services researcher and Andrée le May is professor of nursing at Southampton. Together they have produced a book which is remarkable in many ways, not least in the way that it wears its scholarship lightly and contains, on almost every page, an observation, reflection, or idea to which any practising GP will relate.

At the core of the book is the concept of clinical mindlines; the complex, interwoven threads of information, experience, education, and evidence that act as internalised and highly personal clinical guidelines and heuristics that underlie and, importantly, continually interact with patient management. Using data collected in their own revealing and detailed ethnographic research carried out in four disparate general practices, and drawing on a range of social theory, Gabbay and le May map out the complex territory lying between the publication of research evidence and its application to real-world general practice.

Science, evidence, and published guidelines interact with many other factors such as local norms and routines, tacit and experiential knowledge, peer values, institutional culture and role modelling. We are taken on an exciting intellectual and professional journey through the growth and nourishment of mindlines and on to the development of communities of practice and the co-creation of clinical reality. There is an extremely useful concluding chapter, with important summary points for the improvement of practice-based evidence. The accompanying notes on each chapter are almost as interesting as the chapters themselves, and there is an excellent bibliography. Gabbay and le May have come as close as anything I’ve read to explaining exactly how, as Leonard Cohen has it, ‘the light gets in’.

• © British Journal of General Practice 2014