Chapter 7: Research and evidence-based medicine

INTRODUCTION

Effective research is the trademark of the medical profession. When confronted with the great responsibility of understanding and treating human beings, we need as much scientific evidence as possible to render our decision making valid, credible and justifiable.

Research can be defined as ‘a systematic method in which the truth of evidence is based on observing and testing the soundness of conclusions according to consistent rules’¹ or, to put it more simply, ‘research is organised curiosity’,² the end point being new and improved knowledge.

In the medical context the term ‘research’ tends to conjecture bench-type laboratory research. However, the discipline of general practice provides a fertile research area in which to evaluate the morbidity patterns and the nature of common problems in addition to the processes specific to primary health care.

There has been an excellent tradition of research conducted by GPs. Tim Murrell in his paper ‘Nineteenth century masters of general practice’³ describes the contributions of Edward Jenner, Caleb Parry, John Snow, Robert Koch and James MacKenzie, and notes that ‘among the characteristics they shared was their capacity to observe and record natural phenomena, breaking new frontiers of discovery in medicine using an ecological paradigm’.

This tradition was carried into the 20th century by Australian GPs such as Clifford Jungfer, Alan Chancellor, Charles Bridges-Webb, Kevin Cullen and Trevor Beard,⁴ and now the research activities of the new generation of GPs, academic-based or practice-based, have been taken to a higher level with the development of evidence-based medicine (EBM).

Based on the work of the Cochrane Collaboration and the initiatives of Chris Silagy, Paul Glasziou and Chris Del Mar in particular, research has moved from the relatively ‘pure’ hospital environment to ‘real world’ scenarios which better reflect the circumstances of patients living in the community. Plenty of interventions which seem to work well in sponsored clinical trials are less impressive when measured in general practice. Some other interventions such as lifestyle management turn out to be surprisingly effective once they are accurately measured.

The focus of EBM has been to improve health care and health economics. Its development has gone hand in hand with improved information technology. EBM is inextricably linked to research.

The aim of this chapter is to present a brief overview of research and EBM and, in particular, to encourage GPs, either singly or collectively, to undertake research—simple or sophisticated—and also to publish their work. The benefits of such are well outlined in John Howie’s classic text Research in General Practice.⁵

WHY DO RESEARCH?

The basic objective of research is to acquire new knowledge and to justify ...