Evidence-based medicine and physicians’ institutional agency in Russian clinical settings

Abstract

In 1990s’ Russia, a wave of internationalization brought an evidence-based medical paradigm to Russian healthcare. Whilst there has been considerable critical commentary on the consequences of adopting this paradigm for medical decision-making, much of this relates to specific contexts in Europe, north America and Australasia, with little research addressing post-Soviet clinical practice. Drawing on semi-structured qualitative interviews with Russian physicians, this article explores the entanglements between the introduction of evidence-based medicine (EBM) in the country and the transformation of post-socialist medical professionalism. I single out physicians’ efforts to reconcile the EBM paradigm with organizational constraints as indicative of professionals’ ground-level agency. I define the following components of such agency: (1) selective application of guidelines and use of foreign clinical recommendations; (2) establishing local professional solidarity; (3) developing relationships based on personalized trust with the patients. The study employs two sets of data (gathered in 2018 and in 2020) to trace the EBM-related agency of medical professionals both before and during COVID-19 pandemic. By offering analytical insights from post-socialist healthcare, where doctors’ discretion has historically been limited by excessive state control, the article contributes to academic debate on medical professionals’ autonomy and agency in the era of EBM-related standardization.