Domhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK
The James Mackenzie Lecture is one of the most prestigious eponymous lectures of the Royal College of General Practitioners. The title of the lecture recently delivered by Toronto Professor, Frank Sullivan, certainly grabbed attention. The title, “Atomic Data”, actually comes from cardiologist James Mackenzie’s own ambition in setting up the Institute for Clinical Research in St. Andrews on his return to Scotland in 1918: ‘to do for medicine what the Atomic Theory had done for chemistry’. And, as we may have expected from Frank, whose research interests lie in health informatics, electronic medical records, decision support systems and, of course, community based trials, he explored how “big data” could be used to transform medical research.
Mackenzie, best known for his Polygraph – the forerunner of the ECG – had very wide interests and could see the huge research potential in the accumulated information from general practitioners records. Now, a century later, we recognise how aggregated data from hundreds of practices can be used to define patterns of multi morbidity, create risk scores such as the Q-risk family, and chart change in the treatment of medical conditions following research innovation. Record linkage, that creates data pools from combined hospital and general practitioner records, shows even more potential. But, this reflects just doctor-recorded data and health service process information, and in the future we may be able to integrate personally recorded data using technology such as Fitbits, mobile phones, continuous monitoring or even intelligent clothing.
This is not some vague pipe-dream. Big data is already part of our everyday lives as supermarkets, online retailers and a multiplicity of loyalty card providers monitor our lifestyle and habits, and our mobile phones record everyday activity. Athletes record heart rates at different exercise intensities, and patients are beginning to record their own personal health data. While GPs in busy clinical practices may not individually have time to undertake research, they can be part of a research revolution simply by recording, registering and sharing their data and ultimately contribute to fulfilling Mackenzie’s vision.
It’s not every day that we hear ‘atomic theory’ and ‘general practice’ uttered in a single sentence. But, it’s not every day we have a family medicine academic who is active on two continents either. We might ask if Frank Sullivan from the University of Toronto, Gordon F. Cheesbrough Research Chair and Director of UTOPIAN, was guesting at home in delivering the recent lecture, or was he an international visitor? Some may argue that, as a Scot, he was an international visitor to London on both counts! Modest, self-effacing, and always ready to recognise the work of others, Frank’s contribution to general practice in his native Scotland is immense and his groundbreaking paper on Bell’s palsy, published in the New England Journal of Medicine, certainly put the Scottish School of Primary Care on the map. When he moved to the University of Toronto in 2014 he had an immediate impact and, indeed, some of his Toronto colleagues even made the journey for the recent event.
The Mackenzie lecture was the central event of the day at the RCGP’s Annual General Meeting 2015, but, for me, there were other highlights. Professor Michael Kidd, President of the World Organisation of Family Doctors, was awarded an Honorary Fellowship. Michael has worked tirelessly, traveling extensively throughout the world promoting the role of the family doctor. There was a personal link too and I particularly enjoyed the award of the Chair of Council’s Medal to Professor Sir Denis Pereira Gray, in whose practice I was a GP trainee, long before the more stately title of ‘GP Registrar’. Denis was a previous Chairman of Council and President of the College and still remains very active, recently writing a robust and refreshing critique in the November issue of the BJGP (entitled “Academic general practice: a viewpoint on achievements and challenges”). Denis was also long time editor of the British Journal of General Practice and clearly his immense commitment to communication in medicine, as previous editor or the BJGP and Honorary College Editor, must have had some unconscious influence. Another editor rewarded for her contribution to the literature of general practice was Chantal Simon, who was editor of InnovAiT, an RCGP journal with a focus on education from first entry into general practice specialist training until qualification, and editor of the Oxford Handbook of General Practice.
Cynics might cast a wry smile at the pomp and ceremony of the occasion, with its fancy robes and fellowship awards. But, despite my own reservations about such awards, I came away uplifted and encouraged. There is a lot to applaud in the formal recognition of those who make a particular contribution to healthcare. Many of those general practitioners receiving fellowships were accompanied by their work colleagues and families. For them it was an important day, acknowledgement of their commitment, and a major occasion to be celebrated. Recognition by their College clearly meant a lot.
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