Martin Dawes: Health research: what’s in a name?

Martin DawesEvery year my family tease me about going to NAPCRG, the North American Primary Care Research Group. This is pronounced “nap crag” and it does not take a huge leap of imagination to see how a little mispronunciation may lead to a sequence of “funny” jokes.

As a result of this and partly to get people thinking about the focus of the meeting, last November, I asked the NAPCRG audience of 700 researchers what name they would like. As there was no ethics application I am unable to share the results but the question resulted in plenty of suggestions and discussion. The variety in response partially reflects the fact that we are called primary care physicians, general practitioners, family doctors, and other terms depending on our country and scope of practice.

In this blog I would like to expand the terminology debate. The reason is not only to provide some alternative acronyms but to consider how much and how relevant the research done under this broad umbrella has been and continues to be.

For talks to medical students on research done by family physicians I have a list of twenty or so surprising and important discoveries made by general practitioners over the last 90 years. They include the etiology of Hepatitis A to the use of delayed prescriptions for uncomplicated lower respiratory tract infections. Due to the generalized practice we perform we tend to be interested in most clinical problems though this varies from practice to practice reflecting the diverse nature of the job. The average general practitioner makes 2500 diagnoses per year covering over 450 different conditions. 

Reflecting on this breadth of practice, the problem of how to capture our field of research is challenging. I tried using Starfield’s clear description of the comprehensiveness, continuity, and community aspects of general practice. However having  3C’s (“three seas”) as an acronym would lead people to think we were studying global warming or the benefits of kelp.  Nor does using the setting “primary care” work.  Although the majority of family physicians work in offices or practices, we also work in hospitals, and sometimes out in the wilderness. In North America family physicians work a lot more in hospitals not just visiting patients but being the MRP (most responsible physician). I have clinical faculty who have to deal with severe trauma after driving several hours drive down a rough track in the woods of Northern British Columbia. Here the concept of the golden hour is laughable and the need to have research addressing this scope of practice is as necessary as other areas mentioned above.

We want research to be relevant to our patients but it is not always small scale confined to a small community. There are international groups who have collaborated on interventions for infectious disease  where 14 primary care research networks within 13 different countries have recruited 3,400 patients. The generalisablity of these sorts of studies makes them more applicable in general practice and with the low prevalence of serious problems seen in primary care this collaborative approach is becoming increasingly popular. Our research is not just about common problems; we study the rare as well such as Bornholms’ described by Sylvest in 1932. It is not just work done by doctors by any means and we see and work with many health professions publishing relevant work.

So where does this leave us? Should we have the term “Clinical Applied Research Meeting” (CARM as in calm) but there are plenty of us who dabble in theoretical research who may take issue with this. Maybe “Health Research Conference” and acronyms could include HARC as in “hark”, and of course when it is international we would have the “I Hark.” Another option is Community Health Research Meeting (CHARM). The bottom line is that whatever we call it we need to send a message loud and clear to funding agencies. Research does not just happen in labs and hospitals and is not just about patients with one problem. The most applicable research takes place in settings  where people are seen by health professionals most frequently.