Carmen García-Peña is a Mexican family physician who is currently Head of the Research Division at the National Institute of Geriatrics. She is a keynote speaker at the forthcoming NAPCRG Annual meeting
Family physicians are involved in countless daily activities ranging across a spectrum that may include treating patients with chronic or acute diseases, advising a mother with her first child, trying to coordinate care, providing emotional support, monitoring compliance of preventive programs, resolving administrative problems and, educating future family physicians. Many of these actions are based on clinical judgment, common sense, intuition, a framework that has been built up over the years of practice and, unfortunately, frequently, based on limited evidence and scientific research.
While it is widely accepted that family medicine is a fundamental pillar of any health system, that family physicians and primary care systems improve the health of societies compared to other schemes and that they also increase and promote equity and solidarity, the scientific potential of the specialty has not yet been realized.
The link between science, research and family medicine has been discussed for decades. An essay, for example, written in México in 1990 by Dr. Vazquez Esquivel*, argued that the factors hindering research in family medicine may have both an historical and contemporary origin. This thesis is summed up in the words of Donabedian**:
"The level of quality of services provided in a health system is directly related to the level of professional satisfaction in working on it ... and the demoralization of doctors is the greatest difficulty directors and managers of health centers have to face".
An interesting, or I may say, disheartening aspect is that this detailed analysis of the different variables that inhibit scientific output in family medicine, remains valid and entirely applicable today, 25 years after the article was first published. Indeed, it is somewhat surprising that even in our current era dominated by the rapid advance of science and technology in many fields, we still must ask: Why is family medicine research important? What obstacles prevent family physicians from doing research? Why there is no established scientific culture?
The role of research is not questioned in cardiology, internal medicine, pediatrics and other medical specialties. In family practice, however, it appears that research could be dispensable. It is, however, or should be, the most effective tool to establish the specialty within the health system so that it remains constant despite the whims of health policy makers.
The reasons why family medicine research is so important have already been stated by others in a much effective way: the value of scientific work lies in improving clinical practice, providing better care to families and increasing job satisfaction, and an academic environment is the best vaccine against burnout. The endless number of research questions arising from the practice of family medicine, and that go far beyond the association between family dynamics and health outcomes, are sufficient to create its own discipline. The future of family medicine depends, essentially, on how well family doctors incorporate the best available evidence in their practice, understand and interpret the methods and results of research, and determine which of the questions arising in everyday clinical work should be answered by scientific research.
A family doctor has tremendous advantages over other specialties with regard to the spectrum of research. The family doctor is the professional with the most comprehensive view of the health-disease process. Research methods in clinical practice include quantitative, qualitative and health services research. On a wider platform it also includes epidemiological research and public health as a whole and, in addition, can integrate other disciplines.
An important challenge is to communicate this passion for the endless cycle of science- research question-diffusion-critical-new question- to young doctors. We, as academics, have a responsibility to ensure that research in family medicine becomes part of daily practice.
This is the first in a series of blogs from the 43rd North American Primary Care Research Group (NAPCRG) Annual Meeting, which runs from October 24-28, 2015, in Mexico. The CMAJ is a partner in organizing the meeting.
*Vázquez Esquivel J. Obstáculos para la realización de Investigación por el médico familiar. Rev Mex Med Fam 1990;3:107-112
**Donabedian A. La dimensión internacional de la evolución y garantía de calidad. Salud Pública Méx 1990;32:117-131.