Intended for healthcare professionals

Letters

Qualitative research in health care

BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7251.1729 (Published 24 June 2000) Cite this as: BMJ 2000;320:1729

Good communication is essential part of educational process

  1. William H Isbister, surgeon (isbister{at}kfshrc.edu.sa)
  1. Department of Surgery, MBC 40, King Faisal Specialist Hospital, Riyadh 11211, Saudi Arabia
  2. General Internal Medicine, Brown University Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA
  3. Department of Mathematics, Rutgers University, Piscataway, NJ 08854, USA

    EDITOR—The first Education and debate section of the new millennium was very educational in a way that was almost certainly not anticipated or intended by either the staff of the journal (unless they were being very mischievous) or the authors of the papers concerned.1 2 In the paper by Lilford et al 1 the study under discussion was clearly defined, but unfortunately in the paper by Mays et al 2 I was not able, after reading the paper three times, to find a definition of the type of research being discussed anywhere.

    The style of the paper by Lilford et al allowed an easy understanding of the thesis being developed, but the same could not be said of the paper by Mays et al, which seemed to lack a clearly discernible logic in relation to the case being made. The paper was replete with jargon and many strangely unscientific terms, which made it difficult to read—such as “epistemological,” “extreme relativists,” “antirealist,” “reflexivity,” “inductive inquiries,” and “subtle realism.” No such problem seemed to exist in relation to the paper by Lilford et al. As one of the “researchers from other traditions,” I was appalled to read of research trying to “derive … unequivocal insights.” I thought in my “naive realism” that we sought facts. Should not all research “be concerned to develop theory?” The need to develop a hypothesis to be tested is surely not “arguable.” I was taught by my research mentors that the truth, rather than subtle realism, was what we were trying to attain. It would have been unthinkable to omit a clear account of the process of data collection and analysis.

    In this double blind (I had no idea prior to publication of the content or style), randomised (by chance I chose to read the “unintelligible paper” first) controlled (the papers were controls for each other) trial, not intended by the journal (?), I found a significant difference (I could not even understand one of the papers) in favour of tracker studies. Perhaps this was because of my only admitted bias or conflict of interest, that of being a surgeon and an educator. I am not really sure what all of this means except that if the journal does publish papers for education and debate it follows that they should be understandable to all of the readers of the journal, including such lowly students as surgeons, and that it has to be remembered by educators that an essential part of the educational process is good communication. Quality in qualitative research is a mystery to many health services researchers, and, sadly, it is an even greater mystery to me now. I am left pondering the simple question “Who should be responsible for educating the educators?”

    References

    1. 1.
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    Antirealism is an excuse for sloppy work

    1. Roy M Poses, director of research (royposes{at}brownvm.brown.edu),
    2. Norman J Levitt, professor of mathematics
    1. Department of Surgery, MBC 40, King Faisal Specialist Hospital, Riyadh 11211, Saudi Arabia
    2. General Internal Medicine, Brown University Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA
    3. Department of Mathematics, Rutgers University, Piscataway, NJ 08854, USA

      EDITOR—We were struck by Mays and Pope's indulgent treatment of the antirealist position.1 Antirealist qualitative researchers contend that there is no “social” reality or truth that is independent of the observer. Antirealists, a species of postmodernists, scoff at those naive enough to believe in the physical reality of social world: “what the parochial view in the social, behavioral, and service sciences has touted as ‘science’ is historical and practical myth.” 2 Presumably “social” reality consists of the interactions of human beings—that is, spoken or written words, and all human actions that relate to other humans. Thus the antirealists apparently would contend that this letter has no reality. Antirealists thus fall headlong into self contradiction. If no utterances (presumably including their own) have reality, why should we read what they write? Furthermore, why should we pay any attention to the work of supposedly “scientific” researchers who deny the independent reality of what they research?

      The antirealist view seems to be at best an excuse for sloppy work. Antirealists have argued that bias in research is good—“not something to be eliminated, but is a productive element, a foundation for formulating questions and understanding answers in the process of research.” 3 They have asserted that the traditional notions of methodological rigour, “the classical canons of reliability, validity, and objectivity,” are irrelevant to their kind of qualitative research, to the point that a “powerful case can be made for methodological anarchy.” 4 In retreating to ancient subjectivist attitudes, antirealists have renounced qualities that are part of the scientific attitude: rigour, self discipline, humility in the face of evidence, and willingness to risk failure and blind alleys.

      Alan Sokal, the physicist whose parody of postmodernism in science received wide attention, made the point well. First he decried “a particular kind of nonsense and sloppy thinking: one that denies the existence of objective reality.” 5 Then he wrote, “Intellectually, the problem with such doctrines is that they are false. There is a real world; its properties are not merely social constructions; facts and evidence do matter. What sane person would contend otherwise?”

      We applaud the efforts of Pope and May to bring more rigour to the design, execution, and review of qualitative research. We fear, however, that responsible qualitative researchers will have trouble convincing others of the value of their field until they disavow the pseudo-philosophical nonsense of antirealism.

      References

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