Balancing general practice with research

Professor Rodger Charlton discusses the challenges faced by GPs involved in research projects and how to overcome them.

You will need to devise appropriate research tools for your project (Photo: iStock)
You will need to devise appropriate research tools for your project (Photo: iStock)

You might say you are a busy GP and don't have time for research. The very word can cause anxiety, yet without realising it, we are all involved.

It is likely that you are involved, or have received an invitation to be involved, through your local medical school as part of a research network. Or it could be that you have a burning medical question you wish to try to answer.

Evidence base

Much of our practice is now dictated by guidelines. It is easy to assume they are written in tablets of stone, but medical science is constantly changing. Knowledge changes as a result of research and as practising doctors, we should question and challenge what we see.

We are working at the coal face and curiosity about gaps in evidence-based knowledge should encourage us to find out more.

Differences between audit and research

Audit and research are two different things, although they may sometimes appear to be quite similar

  • Research is a careful search and investigation, which may involve an experiment (intervention), the testing of a hypothesis with the aim to provide new knowledge.
  • Research is there to define that standard or best practice.
  • Audit is performing a check, through a review of patients, to see to what extent a defined standard of care is being met, with the aim of improving services by comparison to a standard.
  • Audit is the agent of change, so ensures that good clinical governance is maintained.

What is research?

Put simply, research is posing a question and looking for an answer. So often in our consulting rooms, we ask ourselves whether a management plan is correct, based on the latest guideline or something we have been taught in the past.

Sometimes we will ask why we cannot find out what is wrong with a patient or why they are not getting better. Much of our research comes from studies in specialist secondary care, which may not be applicable to general practice.

Disease versus illness

Government targets, such as the QOF, are based on objective parameters that are easy to measure, yet much of our work is with patients who are ill (up to 50% in some studies) but as yet have no identifiable disease.

There is much subjectivity in the care of such patients, where their illness is often influenced by complex psychosocial factors, yet it is difficult to argue to our funders how important this healthcare work is, because it is difficult to measure.

Research conducted at the coal face can help to confirm the importance of this everyday work and to inform government, and so help GPs obtain more recognition and help for their work.

The consultation

Many experts have written over the years of the importance of the consultation and GPs have unique insights into illness through our patients.

Potentially, each consultation could lead to a research question or idea and open a floodgate. It is important for us to make the observations which in turn, perhaps through commissioning, will win us more resources.

First ask your question

If you have a question (your research question) that, as far as you know, nobody has answered, you may think you know the answer (your hypothesis) and wish to prove it.

To do this, you need to devise a method with an appropriate research tool, for example, a questionnaire. This forms the basis of your protocol.

Statistics

This is where the academics try to blind you with terminology, such as P values and confidence intervals.

Remember, statistics answer questions about probability, not certainty. So if your observations as a GP differ from the guidelines, you may be right and have a potential research project.

Conducting research

If you have a burning question you want to answer, align yourself to a local university department.

There may be another GP working as a researcher, with whom you can discuss your idea, how you might go about making it into a research project, and any possible funding.

Inevitably, research takes time, and you will require help and funding. A university is a good place to ask for advice. This is the only realistic way a GP can balance general practice with research and for these reasons, being part of a wider project within a university network of GP practices is more straightforward.

  • Professor Charlton is a GP in Hampton-in-Arden, and director of undergraduate primary care education at the School of Medicine, University of Nottingham

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