Speaker says primary care physicians can play crucial research role

“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 better job.”

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 clinical trials.

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.”

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