Another point in Herbert’s article with which I disagree is her criticism of EBM. Those who have articulated the concepts that fall under the rubric of EBM have acknowledged the role of patient preferences and values, pathophysiologic reasoning, and the history and physical examination as essential ingredients of clinical judgement. The clinical epidemiologic research adds the most valid and relevant findings to this mix.4-6 Each source of “evidence” plays an important role in the management of individual patients. Unfortunately, Herbert criticizes EBM because of how it is abused and for the paucity of research available. These are certainly problems, but they are indictments of the users and of insufficient research, not of EBM. The practical application of EBM in a patient-centered fashion (referred to as information mastery7) is the single most important competence we need to add to our training of medical students, residents, and faculty.
Herbert’s approach of asking a basic scientist, an ethicist, and a health promotion expert to describe the role of family medicine research revealed her colleagues were uninformed. I believe her intent was to illustrate that we lack a widespread recognition for our research. That may be useful information, but given our developmental stage I do not find it surprising. For the past 5 years I have chaired the North American Primary Care Research Group’s Committee on Building Research Capacity and the Association of Family Medicine Organizations Research Subcommittee and directed 4 research capacity building workshops involving the chairs and research directors of 29 family medicine departments. I see a vision of the scope, role, and nature of family medicine research coming into sharper focus. Practice-based research is clearly a central contribution of family medicine research. Family medicine research is primarily integrative in nature, using multiple methods. The paper Stange8 presented on this topic at the Keystone III Conference articulates much of this vision.
The delivery of personal preventive health services is an example of an important body of knowledge to which family medicine researchers have contributed significantly. The American Academy of Family Physicians’ groundbreaking initiatives have led to the development of 3 family practice research centers, a national research network, a national policy research office, and a large number of family physicians receiving advanced research training. We are developing research in our discipline as we should; the recognition will come in due time. More important, we are producing original research and translations of that research that will provide family physicians with the knowledge that they are obligated to bring to their relationships with patients.
Conclusions
General practice was reinvented as family practice in the United States in 1969 as a response to society’s need for a personal physician to provide medical care. The need for a trusted physician-patient relationship has not changed, but that relationship will be expressed in different ways. How patients need us to serve in that relationship has changed, and we must adapt. We must embrace and contribute to emerging knowledge and translate that knowledge into beneficial care as partners with our patients, collaborate more with our colleagues in other disciplines, and add information mastery to our armamentarium. By doing so we will reinvent family practice again—and probably not for the last time.
Acknowledgments
My thanks to Robert Blake, Mary Barile, Jack Colwill, and Steven Zweig for their thoughtful review of this manuscript.