> I did an unusual thing this week. I sat down and read the College Journal
> from cover to cover,
mistake # 1 - about as useful as reading the lancet from cover to cover -
don't do it . I checked the same issue (not one of the best) and learned
something new - about use of simple home bp monitoring insstead of ABPM -
and marked a few references to get from the library on that one. There were
some pretty iffy papers but another that represented a serious attempt to
get into the debate about whether GHQ style questionnaires are useful. Sure
it didn't quite deliver the goods - but then that charge has been levelled
at the biggest trials this year such as HOT and the newly released UKPD
studies. And before you ask why this would be useful, think back to the
number of unfounded "expert" recommendations to GPs to do GHQs to screen for
depression so everyone can be happy again.
> It beats me what we are paying for if this is the best that
> British general practice can produce.
It's not. The best GP papers inevitably go to things like the BMJ GP
section. Most of the best of british GP is, anyway, either tied up with the
day job or, if "academic" struggling to get teaching going in primary care.
You know how few academic GPs there are, you also know that the career
structure is wrong - I reckon it takes 5+ years of full time practice to
know the job before meaningful research is possible - and the incentives to
switch tracks at that stage are not there.
>Are academics so out of touch with reality that they
> cannot think of useful things to research anymore?
not the few I know, but getting recognition that anything other than a
cut-and-dried RCT is valid research (whether from funding bodies or from
fellow GPs who then deride RCTs as irrelevant to their daily practice) is
difficult.
Perhaps research networks will provide some answers here - our fledgling
network is already considering studies of BP management in PC and the safety
of / patient attitudes to warfarin in the elderly amongst several other
things - all derived from day to day clinical problems. Who knows perhaps
one day we'll appear in the BJGP.
Time to dig the bunker.....
Chris
Dr Chris Burton
GP, Sanquhar, Dumfriesshire
Member of WestNet, The West of Scotland Primary Care Research Network
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