Let’s build a bridge from ‘swamp’ to ivory tower

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General practice academia seems to have a PR problem, and not of the rectal variety.

Last year’s RACGP AGM marathon was memorable for me when an esteemed GP clinician sarcastically referred to a fellow GP clinician academic as living in an ivory tower.

The implication was that an academic couldn’t know what was going on at the coalface, and therefore their ideas were unworthy.

Out of touch, misled, on their high horse, banging their own drum —  these are all phrases commonly heard next to the word ‘academics’.

Yet no other medical specialty seems to talk with the same disdain about their academic colleagues as GPs do.

As one who works as a GP at the same time as undertaking a PhD, I straddle the land of the ivory tower and the deep dark ‘swampy lowlands’ of general practice.1 I spend half the week or so in each.

Academia measures time based on when you completed your PhD and so I’m currently an academic fetus.

I plan to hand in my PhD in a year (or so), but until then, non-clinician academic colleagues scratch their heads as they don’t quite know where to put me.

So where does all the suspicion of academia come from?

Let’s look at some media headlines announcing latest research:

“GPs carry out consultations in as little as two minutes, study finds”.

“GPs should provide patient data for research ‘as a public good’”.

“GPs need better training to help children affected by domestic violence”.

“One in 10 parents do not trust GPs with their child’s healthcare: survey”.

“GPs not carrying out basic checks on children with fever, study shows”.

With so many headlines about what GPs should have done and could be doing, it’s no wonder the GP clinician becomes suspicious of any researcher holding a clipboard.

However, to excel for our patients, we need high-quality, cutting-edge general practice research. For this research to happen, we need solid bridges between the two worlds of academic and clinical practice.

And let’s not forget that the best Australian general practice research has been celebrated internationally.

The work of Professor Clare Heal, of James Cook University, comparing sterile and non-sterile gloves for minor surgery was named in the top 20 articles published in 2015 by the American College of Primary Care Physicians.

As a great example of a question from the ‘coalface’ answered by perfect research methods, the research showed that minor procedures carried out with sterile or non-sterile gloves had the same rate of infection.

Applying these findings, GP clinics can save money using non-sterile gloves for minor procedures.

Practice-based networks are a success story around the world. Groups of clinicians meet alongside academics and researchers to come up with important questions, and excellent methodology for answering them.

Funding for such groups has been difficult to come by since the demise of the Australian Primary Health Care Research Institute — and funding of primary care research is a story in itself.

Social media is another space where academics and clinicians can exchange ideas. Academic GPs in the UK seem to have taken to Twitter with gusto. I have learned much from reading the papers they tweet.

Conferences should be places where networks can be built and relationships enhanced, but it seems to me there is a divide here: academics attend the Primary Health Care Research and Information Service conference, while clinicians attend the RACGP conference.

We need a better melting pot where both share experiences.

Professor Michael Kidd, executive dean of the faculty of medicine, nursing and health sciences at Flinders University, has noted that primary care can seem like a black box to people from the outside. Oftenpolicymakers see it this way.

GP clinicians need their GP academic colleagues to shine the light on questions that must be answered.

And GP academics require close contact with those working in the swamplands to never lose touch with what matters to patients.

The best research comes from the collision of ideas, relationships and connections — then questions are answered about how, when and why general practice works.

When those in the ivory tower and those in the swampy lowlands work together, we create the best general practice research in the world.

1. Dr Louise Stone, of ANU, first referred to general practice as ‘swampy lowlands’ during an address at the 2011 GPET Convention.

First published on 1 February 2017 at Medical Observer (editor Jo Hartley)  https://www.medicalobserver.com.au/professional-news/let-s-build-a-bridge-from-swamp-to-ivory-tower

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