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I am glad I seem to have initiated a debate about practice-based research and its publication in the BJGP, but find myself accused as thoughtless by a guru and ignored by College prelates who responded to his blast concerning his own agenda.
My initial letter1 was to support Ian McWhinney's concern about the lack of publication of research on clinical insight or discovery by GPs. The Editor of the Annals of Family Medicine responded immediately by inviting submissions on ‘emergent discoveries based on careful clinical observation’ from its readership. The Editor of the BJGP has made no such offer. Julian Tudor Hart presumes that I (and presumably McWhinney) have not thought deeply enough about the issue but also urges us all to have an unshakeable faith in the Editors' wisdom and insight in the matter.2 He has no doubt that if good clinical research by GPs in their own practices were submitted, the Editor would be delighted to publish it.
There the matter might have rested had his rambling tirade not been responded to by three College representatives,3 and they demonstrate why I was probably correct to be concerned. It seems that clinical researchers in general practice are indulging in ‘occupational therapy for doctors’ and they declare, seemingly on behalf of the College, their belief that the days of the ‘gentleman amateur’ working to produce research in a general practice ‘cottage industry’ are now over. It seems that GPs now have to be members of research networks before they can be researchers. Presumably, it will only be these fortunate enough to rise to the top of these pyramid schemes who will qualify for the RCGP Discovery Prize for original research in general practice.
I may not have thought deeply enough about all this but it was my impression that the discipline of general practice was about the delivery of primary, personal, and continuing care of individuals, families, and practice populations. It is therefore, imperative that research is carried out by individual GPs in their own practices, and for three College prelates to suggest otherwise is outrageous. Of course research networks are important and we must encourage the academic activities of academic departments, but these will only produce abstractions and generalisations about general practice, which are only one side of the story. As McWhinney pointed out, quoting from James, we also need ‘an acquaintance with particulars’,4 which can only come from practice-based research.