Was the paper I wrote a fraud?

Editor,-The personal view of C Bowie in the BMJ1 highlights an important area of attempting to retrospectively confirm that research was indeed carried out by contacting patients long after the assessment. Do patients remember being previously contacted and assessed ?

To shed some light on this question, the first ten contactable community treated patients on the Tees Stroke Register, still living in their own homes, were telephoned. Each was initially assessed at home soon after their stroke by a research doctor, three weeks later by a telephone assessment by a research nurse, and six months after the stroke by a self completed postal questionnaire. None of the ten had more than these three contacts with the stroke register, the last contact being on average more than two years ago. All had given written consent, and had all the assessments completed. Each was phoned and they and/or their carer was asked whether they remembered being assessed by a doctor from the stroke register soon after their stroke, were telephoned by the stroke research nurse soon thereafter and whether they completed a postal questionnaire for the stroke register. The results are in the table.

Case  Examined Phoned  Questionnaire
1	Y	Y/NC	Y
2	Y	Y/NC	Y
3	Y	NC	N
4	N	Y	N
5	Y	N	Y
6	Y	N/NC	Y
7	Y	N	NC
8	NC	Y/NC	Y
9	Y	N/NC	Y
10	N	N	N

Y:Yes,  NC: Not Certain,  N: No

Only one person was certain that she was phoned by the research nurse (and stated what was asked), but surprisingly she did not remember the medical assessment nor the self-completed questionnaire. Five were not certain of being phoned, three of whom thought it probably did occur. Whether they would have answered similarly over six years after the event is a matter of conjecture.

So what conclusions can be drawn from this limited sample ?

1: Of the three forms of assessments, telephone assessments are least likely to be remembered.

2: Trying to check whether a telephone assessment was carried out in the past, by contacting the patient/carer is of no benefit. One may not be able to differentiate whether some/none/all the claimed assessments were performed or not.

With respect to Cameron Bowie’s failure of finding even one person remembering the telephone assessment, that is not evidence that the assessments did not occur. Even if some patients remembered, that still would not be evidence that all the assessments did occur.

When doing prospective assessments, the only means of confirming whether a patient is alive on the day of the assessment is by phoning the patient/carer, thus a possible way to check whether previous assessments may have been done is to check whether the patient was alive at the time of the claimed assessment. A person who goes to all the effort of determining whether a patient is alive and obtaining their contact number (about half the work of doing a telephone assessment) is more likely to have actually done the assessment.

Ideally, in retrospectively attempting to confirm that a study was undertaken, the original paper copies (or computer database) in some instances could be compared with GP/hospital records for consistency. However, this has implications with regards to the long term record storage security and confidentiality. Best is potential fraud prevention by ongoing review of the methods and preliminary results at the time of the study by the co-authors.

AKIF GANI: Clinical Research Associate, Tees Stroke Register, Departments of Medicine, Epidemiology & Public Health, University of Newcastle, NE2 4HH

1. Bowie C. Was the paper I wrote a fraud ? BMJ 1998;316:1755 ( 6 June ).