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Viewpoint Indian Pediatrics 2001; 38: 376-377 |
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Research in Office Practice |
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Currently, in our setting, the contribution from office practitioners in medical research is little or negligible, ‘Office practitioner’ here includes only those who are seeing patients in their clinic or office and are not attached to any big or teaching hospital. The reasons for this scenario are manifold: one of them is time. A private practitioner’s time is money. He is working alone and has many tasks to look after. Unlike faculty members he does not have limited working hours with many holidays thrown in. He does not get support of colleagues, PG students, paramedicals and statistician, etc. He does not have access to free/subsidized tests involving microbiology, serology, biochemistry, radio-logy and so forth. Then there is also the very important question of funding. Thus his work atmosphere has many constraints. There is another problem – the attitude to research. Thesis writing in post graduation should serve as the eye opener to the wonderful world of research, a beginning. But the opposite is happening – thesis is considered an ordeal and thesis submission is the end of the ordeal, never to be looked back at again. Invariably the topics are unimaginative, methods questionable and results biased. Once the PG is out of institution and into the private practice he is busy building it up and research is farthest from his mind and remains so even when he has established himself. He then goes to conferences and updates a few times a year and passively listens to the wisdom bestowed upon him by speakers. He picks up odds and ends of it and then comes back and applies this wisdom to treating his patients for the rest of the year. The ‘office practitioner’ is content or resigned to his fixed role of audience in scientific meetings. Either he does not care or he does not know how to bring about a change in this situation. Such is the fate of a once brilliant mind. This scenario is frustrating for academically oriented private practitioners who want to be a part of the decision making process and are somewhat tired of being passive receptients of scientific wisdom. There is undoubtedly a need for a broader debate on this topic. There is a need for development of a structure and process for pediatric practice based research and provision of research opportunity to practitioners. Private practitioners with limitations imposed by their work atmosphere can not compete with or outdo faculty research in depth and range but can definitely indulge in research suitable to their work atmosphere. Private practitioners make the bulk of pediatricians in the country and their experience and clout must be used to enrich the research experience in the country as a whole which at present is not happening. They can work in networks, their data can be pooled and results analyzed to derive conclusions by the networking body. Selection of topic will be an important issue. Since their work atmosphere is typical and constraints many, they should avoid topics which rely heavily on complex and expensive laboratory or radiological investigations, require a big team, huge sample, lots of outdoor activities, etc. For examples if they chose a topic like "Fulminant Hepatic Failure-Etiology Viral Markers and Outcome"(1), research will entail evaluation of serum samples for several viral markers, liver function tests, renal function tests and special invesigations like alpha fetoprotein, copper studies, blood culture and drug levels. These complex and expensive tests are likely to make the study improbable. On the other hand if they chose a study like "Change in Nutritional Status and Morbidity Over Time Among Preschool Children From Slums in Pune"(2) the challenges will be different. Although the study will not requaire eleaborate laboratory tests it will need a huge sample, manpower and outdoor activities. Can some topics be suitable and workable in the setting of office practice? Topics like "secondary sex characters and onset of menarche", "identification of behavioral dis-orders in office practice of pediatricians" and "Pediatrician – specialist referrals – parent’s satisfaction score" should not prove difficult. These are mere suggestions; many more and better topics can undoubtedly be thought of. As the network matures, they can go for more complex topics. The American Academy of Pediatrics already has a cell Pediatric Research in Office Setting (PROS)(3,4), which is guiding pediatric practitioners to carry out research. The Indian Academy of Pediatrics has also taken an initiative in this direction recently and offered to provide financial assistance to private practitioners to carry out such research. One thing is sure, if the practitioners enter this vague and undefined jungle and scout around cautiously, sooner or later they will hit upon tracks that will lead them to wider pastures of academic satisfaction. Funding:
None.
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