Electronic Thesis and Dissertation Repository


Doctor of Philosophy


Library & Information Science


Dr. C. Nadine Wathen

2nd Supervisor

Dr. Roma Harris


While evidence-based medicine (EBM) is a widely accepted feature of contemporary medicine, the applicability of evidence to clinical practice is often questioned. The proprietary system UpToDate has emerged as one of the most heavily used point-of-care evidence resources. While some existing research evaluates UpToDate’s utility and features, no critical analysis of its content exists. This thesis is a multiple, mixed methods case study examining how evidence, authors, and the patient-physician relationship are situated in UpToDate. A descriptive analysis of the type and features of the cited evidence, as well as an overarching textual analysis of the clinician and patient information entries was completed for seven cases (conditions), chosen to represent different levels of certainty (with respect to diagnosis and/or treatment), medicalization, and contestation (with respect to the ‘legitimacy’ of a condition). Cross-case analyses were also conducted. Data analysis was informed by the field of Science and Technology Studies, which recognizes the study and development of science and technology as social and interactive processes. Findings indicate that, in the absence of explicit and transparent guidelines, authors who contribute to UpToDate adhere loosely to the general principles of EBM. The content of entries suggests that UpToDate acts not only as an evidence provider but as a ‘mentor’ and ‘curbside consultant’ to users, functioning as a technological surrogate for in-person interactions. UpToDate is an attempt to bridge a real gap between evidence and practice, however, this study brings to light signs of a ‘hidden curriculum’ embedded in this clinical tool. While on the surface UpToDate is designed to support ‘scientific’ practice by incorporating clinical judgment, expertise, and advice about tailoring care for patients with research evidence, it may also perpetuate physician-centred, rather than patient-centred, care, and focus on the “art” rather than “science” of medicine, seemingly contradicting EBM’s core purposes.