The BMJ should be adventurous and lead the way on qualitative research

This letter sets out the academic case for The BMJ to publish qualitative evidence and rebalance the incessant drive for quantitative data.1

Any clinician seeing real, unselected patients knows the bald numerical data of randomised controlled trials (RCTs) and meta-analyses, while helpful, completely fail to capture the human dimension of clinical practice. Despite the extensive bioscientific research base, there are (perhaps especially in general practice, geriatric medicine, and psychiatry) many gaps in the evidence informing our decisions. Psychosocial research has been sadly neglected. This is especially pertinent in patients with the increasingly prevalent multimorbidity. Here, conventional RCTs, for all their carefully curated internal validity, have diminishingly impressive external validity (applicability to my patient). Indeed, the third to sixth (of six) priorities in a 2012 Institute of Medicine report,2 quoted in an editorial at the time,3 asked for quality of life to be investigated.

Hundreds of thousands of patients’ worth of trials in hypertension and stroke have very little impact indeed on a large proportion of the frail older patients with multimorbidity that I see daily. Even when excellent trials exist, knowing how, and indeed whether, to apply the results is challenging.4 5

Surely the McNamara fallacy is looming ever larger?6 Qualitative and quantitative approaches are not competing imperatives, but ones that complement each other—both in clinical practice and thus crucially in the underpinning research.

Please live adventurously. Take up the exciting challenge offered by the authors. Here is a golden opportunity for The BMJ to blaze another innovative, exciting, and educational trail through the dense undergrowth of clinical practice. I for one would be an enthusiastic follower.