Intended for healthcare professionals

Letters Primary care’s lost cause?

Not lost if it combines medical and social science approaches

BMJ 2010; 340 doi: (Published 26 January 2010) Cite this as: BMJ 2010;340:c462
  1. John Howie, emeritus professor of general practice1
  1. 1University of Edinburgh, Edinburgh EH8 9DX
  1. john.howie00{at}

    Del Mar asks if primary care research is a lost cause.1 Two institutional realities threaten it. Firstly, medical schools must search for large sums of research money to survive. This results in restructuring of research activity and the pursuit of high earning high technology activities, neither of which fits the preferred agendas of academic general practice.

    Secondly, reordering general practice to promote incentivised public health interventions and allowing general practitioners to opt out of out of hours care has seriously compromised continuity and the primacy of patient agendas at general practice consultations.

    By accepting these realities, academic general practice has risked losing its intellectual and research identity, and moved into evidence based research at the expense of work on the consultation, patient centredness, and holism, which del Mar—I think wrongly—suggests belongs to the past.

    Del Mar referred to my work on prescribing for respiratory illness in the 1970s.1 My first study was a randomised controlled trial that showed no benefit from antibiotic use in a normally healthy working age male population.2 I have tried to find out why these findings have had so little effect in changing clinical practice. Work on the consultation and on patient centredness has helped most. I was recently invited to revisit another early study from the 1970s, and to comment on its relevance to modern clinical practice.3 This has confirmed for me that for general practice research to contribute to the future of medicine in the way patients most need today, it must be through a combination of medical and social science approaches.


    Cite this as: BMJ 2010;340:c462


    • Competing interests: None declared.