I believe that all GPs and their allied health care teams have intellectual questions they would like to answer at some stage in their careers.
We work with our patients and care teams to offer best diagnoses and management but the evidence underpinning our practice is frequently shaky. For instance, I recently looked with colleagues at current insect bite practice and the ability to distinguish an insect bite reaction from secondary infection [1] and we found no primary care literature to help us. I recently wanted to explore the primary care diagnostic interval in oral cancer [2] and found little, even internationally, research undertaken in general practice. I recently wondered why patients stopped a particular topical medication and found no literature. The questions with which you and I could improve patient care are almost endless, so I urge you to get involved.
Some GPs opt to work partly in universities or with pharmaceutical companies and there are often studies undertaken by secondary care specialists. Whilst these are valuable there is a need for increased general practice knowledge. Much of our guidance is derived from secondary care studies. General practice meets untriaged symptoms and the safety of sending patients home often depends on negative as well as positive predictive values of symptoms and signs. We meet problems of multimorbidity and polypharmacy daily, we weigh up overdiagnosis and underdiagnosis of investigations in both near and long-term plans and wonder about the efficacy and side-effects of medications routinely recommended amongst our patient groups. Have I got you thinking about research projects? I hope so.
The next step is knowing where to start, having some overview of where to go with your idea. This GP Excellence research website is a great guide.
For me, I have a curiosity which drives me to ask questions and try to answer them. I am a small, tiny independent GP researcher, not funded and doing research in my own time. I believe if we all made one step in improving knowledge then the gains for our patients would be vast. Have fun and enjoy the challenge, be the change and create an intellectually questioning arm to your general practice skills.
Jane Wilcock, GP, educator and researcher at Silverdale Medical Centre Salford.
References
1. Insect and tick bite management in general practice https://www.bjfm.co.uk/insect-and-tick-bite-management-in-gp-general-practice-survey-and-literature-search
2. Diagnosis and referral delays in primary care for oral squamous cell cancer: a systematic review https://bjgp.org/content/69/679/e112/tab-article-info
