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How to ask questions about research

Professor Rodger Charlton explains how research can be undertaken by GPs in everyday practice.

Dr Charlton: ‘GPs are researchers without realising it. You don’t have to be an academic to do research’ (Photograph: NTI)
Dr Charlton: ‘GPs are researchers without realising it. You don’t have to be an academic to do research’ (Photograph: NTI)

We talk a lot about evidence-based medicine and guidelines as if they were set in tablets of stone and unchangeable. But we should remember they are only guidelines and medicine does change.

As GPs we are researchers without realising it. We make observations about new guidelines and treatments and, as we review patients, we quickly observe what works and what does not and hence the gaps in evidence-based knowledge.

Like our patients we become curious and want to find out more. You don't have to be an academic in an ivory tower to do research.

What is research?
How many times do you consult and make a decision and find yourself asking whether the management plan is correct based on something you have been taught in the past? Or you notice that a particular therapy is not working as you have been informed it should and you wonder if it might be worth trying something different? Research follows observation, which we do all the time as GPs, and asking a question and looking for an answer.

Evidence-based medicine
We are encouraged to inform our practice through evidence-based medicine. But this is largely derived from secondary care and so specialist hospital practice. Hospital doctors and GPs are seeing different spectrums of disease and to complicate matters, in general practice not all of the patients we see have disease.

So in many cases, the relevance of evidence-based medicine is questioned as GPs take into account the influence of psychosocial factors. Each consultation could lead to research ideas and open a floodgate.

Think of the patients who say they are tired all the time. Why are they tired all the time? An analysis of their records may reveal some common factors between the patients. Research can be defined as a close careful study through scholarly or scientific enquiry.

Consider a research project
You may have a burning question (called the research question), for which you want to find the answer, that as far as you are aware, no one else has found. How do you do this?

Create yourself a simple research protocol. You may believe that you know what the answer is, but you are not sure and you wish to prove it. What you believe is your hypothesis and this is what you need to test.

Once you have written your research question and hypothesis, you need to think about how you are going to answer the question and so find out if your hypothesis is correct.

This is your research method and you may use a research tool, such as measuring a person's Hb or a questionnaire.


Research is a careful search and investigation, which may involve the testing of a hypothesis with the aim to provide new knowledge

Audit or research?
Is audit research? There are arguments for and against. For those of you who are pedantic about the use of terminology, the following may be of help.

Research is a careful search and investigation, which may involve an experiment (intervention), the testing of a hypothesis with the aim to provide new knowledge. Audit is performing a check through a systematic approach to review healthcare and has the aim of improving services by comparison with a standard.

Research may define that standard or best practice. However, audit is the agent to change practice.

Statistics
Statistics are not complicated, only the terminology. The use of statistics is where academics try to blind you with mathematical jargon. However, the principles are simple and don't let researchers fool you that everything hangs on statistics and the terms that many of us understand, such as p values and confidence limits.

The key point to remember is that statistics answer questions about probability, not about certainty. All that these statistical terms inform us of is a probability that a research finding is representative of the truth, for example, a medication used in an asthma trial.

Informing future practice
Anyone who advocates change in the NHS should be able to justify it. GPs are involved in subjective areas of practice, organisational issues and social aspects of care.

Although a particular area of practice has become established as best practice, politicians can change our practice for ideological reasons. Often we may question whether this has a sound theoretical base or is based largely upon rhetoric.

As GPs we have the wisdom that comes from the ongoing experience at the 'coal-face' of seeing patients. If you are not in agreement with a new idea you need evidence to say that it is incorrect and an observational research project as suggested in the CPD impact box (left) will help you argue objectively.

You could write a paper to 'authorise' these findings following the project, but that is another article.

Remember where a research project involves more than documenting an observation or an evaluation and involves an intervention (experiment) where one group of patients get a treatment and a control group does not, this requires approval from an ethics committee - this is also another article.

  • Professor Charlton is a GP and a professor of medical education at Swansea University.

 CPD IMPACT: EARN MORE CREDITS

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Talk to the practice team and decide on a simple and useful audit that you can conduct in your practice. When completed, share the results with the practice team. This will be a requirement when revalidation is brought in later this year.
  • If your observations as a GP differ from evidence-based medicine guidelines, don't doubt your observations - you may be right - and think about a research project. For example, do urine infections where urine culture provides sensitivity to a particular antibiotic, such as trimethoprim, always respond and so how reliable are these sensitivities?
  • Read a research paper and try to decide whether it is a good paper or not, based on how clear the research protocol was. For example, are the research question and hypothesis clearly stated? Did you understand the method employed? Were the results clear and the statistical tests explained? This will allow you to make a valid critical appraisal of the paper and whether such a paper should guide your clinical practice.

Save this article and add notes with your free online CPD organiser at gponline.com/cpd

Take clinical tests and claim certificates for CPD at myCME.com/gp

 


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