(ATHENS, Ohio — Nov. 25, 2014) With ever-increasing emphasis being
put on improving the quality and efficiency of U.S. health care, the
time for more primary care research is very much upon us, according
to a family medicine physician who says he first became a researcher
almost by necessity.
“I didn’t do a lot of research in
undergraduate school or in medical school,” recalled John Hickner,
M.D., M.Sc., in a talk at the Ohio University Heritage College of
Osteopathic Medicine Oct. 16. “I never saw myself as a researcher,
but I did see myself as very curious.”
That curiosity, Hickner said, is one factor that helped push him
into research. Another was learning that he could find little or no
existing research to guide his treatment on some important medical
issues affecting his patients, which caused him to become
disillusioned about the limitations of current medical knowledge.
“A lot of this stuff didn’t work,” he said. “I would send
patients off to specialists, and they would come back no better.” He
finally got “hooked” on doing research, he said, because “I was just
concerned about the care of my patients, that we could do a lot
Hickner, who chairs the family medicine department at the
University of Illinois at Chicago School of Medicine, was invited by
the Heritage College Office of Research and Grants to speak on the
topic of advancing primary care research, building upon the
college’s efforts to expand its primary care research agenda.
In his talk, Hickner suggested that if primary care physicians
want answers to questions important to their patients, they can and
should do the research themselves.
He reviewed a history of primary care research by physicians,
such as the work of Curtis G. Hames, Sr., M.D. (1920-2005). Hames’
status as a trusted community doctor in Evans County, Ga., helped
make a success of the Evans County Heart Study, the first National
Institutes of Health-sponsored epidemiological project to evaluate
cardiovascular disease in the entire population of a bi-racially
diverse community. The rich database Hames collected from his
patients over 25 years has since been the basis for research
projects around the world.
Hames also helped pioneer the notion of the practice-based
research network (PBRN), which Hickner suggested is perhaps the best
vehicle for collaborative research by practicing physicians.
Hickner said early PBRNs had passionate leadership and strong
grassroots participation from private-practice physicians, but were
seen as a fringe movement in the research community. Around
2000-2004, however, such networks were “discovered” by other
researchers and by important funders such as NIH and are now seen as
a useful tool for furthering translational research. He suggested
that physicians who know their patients can often get better
participation rates for studies than those obtained in large
Hickner stressed that because of the slot primary care physicians
fill in the health care system, they see a mass of data not
available to the specialist or the scientist doing clinical trials.
They are also more aware of psycho-social factors that can
contribute to illness, he said.
He offered a list of potential topics for primary care research
and ways in which practicing physicians can contribute to research.
Potential research areas, he said, include conditions whose
treatment begins and ends in the primary care physician’s office,
such as urinary tract infections, dizziness and mild mental health
problems; the transition of symptoms such as fatigue, shortness of
breath or edema into illness or disease; intractable problems often
seen by primary care doctors, such as chronic pain; the value of
screenings in disease prevention; and the impacts of a close,
trusting doctor-patient relationship.
Primary care physicians, he said, are well-placed to detect early
symptoms of illness and to test new models of practice and treatment
strategies. They can also aid in more traditional clinical research,
he said, by helping to frame research questions more effectively,
critiquing study designs and proposing areas of investigation.
“It’s often the doctors out in the field who can spur the basic
scientists on to ask the questions that matter,” he said.
Hickner suggested the need for such work has never been greater.
“We don’t really have any choice but to do primary care research,”
he declared. “It’s not optional.”