Electronic Letters to:
|
|
E-letters: Electronic letters published:
-
![[Read eLetter]](/icons/misc/sectionDOWN.gif)
Unquoted, unchallenged – or just not found?
- Trisha Greenhalgh (29 September 2005)
|
|
|||
|
Trisha Greenhalgh, Professor of Primary Health Care University College London
Send e-letter to journal:
|
Van Weel and Russell, lament in their editorial that family practice research has gone unnoticed (1). But their editorial is embarrassingly short on critical commentary on the research design used by Mendis and Solangaarachchi, who downloaded 50288 articles indexed as ‘family practice’ from Medline, and found that most had been cited only once or not at all (2). Even if we ignore the fact that a citation does not necessarily equal scholarly influence (one might cite a paper, as in this letter, when seeking to highlight its flaws), there are several reasons why research relevant to family practice is hard to find on Medline apart from papers being 'lost' in specialist topic-specific journals. 1. Medline indexing depends on human judgement and is vulnerable to human error and inter-rater variability. ‘Family practice’ means different things to different people and in different contexts . As van Weel and Russell point out, it overlaps with ‘family medicine’ (46045 articles in PubMed), ‘general practice’ (58417 articles), ‘primary health care’ (46409 articles), and also with 'primary nursing care' (1840 articles in Medline and many more in CINAHL). But the overlap is alarmingly weak. A total of 57210 articles are indexed by these three alternative MeSH terms but not as ‘family practice’. Using my own publications as a worked example, 8 of my papers would have been found by Mendis and Solangaarachchi’s search and 4 more by using the three alternative MeSH terms. Of these twelve papers, four are not about family practice or primary care. But a further 15 of my papers indexed on Medline and describing either family practice research or systematic reviews on topics directly relevant to family practice are not listed under any of these four MeSH headings. 2. Family practice is a practical, applied discipline. Its theoretical base is drawn from a wide range of primary disciplines (e.g. biomedicine, epidemiology, psychology, sociology, economics, philosophy, and so on). A paper on the dynamics of the consultation, for example, might be indexed as ‘social psychology’ rather than ‘family practice’. But the complex interdisciplinary foundations of family practice are as yet weakly developed, and some of us see this conceptual work as a key priority if family practice is to gain credibility in the academic community. For example, my own papers on the application of narrative theory, complexity theory, social network theory and knowledge translation in family practice research have been extensively cited and used to inform empirical work by other researchers. Such papers would only have been captured by a sophisticated back-tracking search technique that detects and acknowledges the reference lists in empirical papers, not by a simple screen by a single MeSH term. 3. Research undertaken IN family practice may not be ABOUT family practice (for example, the large-scale population databases used by epidemiologists in the UK are generated largely through data capture in GP consultations), and conversely, research undertaken beyond family practice may be highly relevant to our work as family practitioners. Stange et al reminded us a few years ago that the knowledge base of general practice includes (a) self-reflective practice by clinicians, (b) involving the patient voice in generating research questions and interpreting data, (c) inquiry into the systems affecting health care, and (d) investigation of disease phenomena and treatment effects in patients over time (3). Some but not all of the papers in each of these different applied research fields will map to the knowledge base we require in our own field. I agree the time is ripe to consider what research is happening in family practice and whether anyone is taking any notice of its findings. But like all scholarly enquiry, this question needs a clear focus, a sensible research design, and rigorous methods of data collection and analysis. Perhaps a good place to start would be an interdisciplinary partnership with an academic librarian. Trisha Greenhalgh MD FRCP FRCGP Professor of Primary Health Care University College London References (1) van Weel C, Rosser WW. Unquoted, unchallenged, general practice research will be casting pearls before swine. Fam Pract 2005; 22(5):471- 473. (2) Mendis K, Solangaarachchi I. PubMed perspective of family medicine research: where does it stand? Fam Pract 2005; 22(5):570-575. (3) Stange KC, Miller WL, McWhinney I. Developing the knowledge base of family practice. Fam Med 2001; 33(4):286-297.
Conflict of Interest:None declared |
|||