Every Patient - a unique challenge

In 2010, Christian Mallen, a GP with a research interest in musculoskeletal disorders won the first annual Yvonne Carter Award, jointly presented by the RCGP and the Society for Academic Primary Care (SAPC). Four years have passed and he is now a Professor of General Practice Research and the Director of Clinical Academic Training at Keele University and the Secretary of the SAPC. Find out more about why he supports his role as a GP through his research activities and how patients benefit from being involved in primary care research.

Your specialist areas of research in general practice is musculoskeletal research. What is it that drew your interest in this area originally?

I originally became interested in musculoskeletal disorders because of my complete ignorance in managing them. I was fortunate to have fantastic undergraduate training in rheumatology (provided by Prof Doherty in Nottingham) but had almost no exposure during my postgraduate training. As such I sought out the unit at Keele on my VTS to try and learn more. I was very lucky to join the unit at a time of growth and to have had the opportunity to develop my research skills along with my clinical interests.

What are the challenges for GPs when faced with patients with musculoskeletal problems?

The early identification of potentially serious pathology is always challenging in general practice. Pain, especially joint pain, is a really common reason for a GP consultation, accounting for one in six encounters in general practice. In contrast, patients with a new onset inflammatory arthritis are few and far between, with the average full time GP making one new diagnosis of rheumatoid arthritis every 1-2 years. With advances in treatment for patients with conditions such as rheumatoid arthritis it is essential that we try to fast track patients with suspicious symptoms for specialist evaluation. As GPs we need support to allow us to get the right patient to the right service at the right time. With increased pressure on limiting referrals to secondary care this is more important now than ever before.

As a GP what do you feel are the challenges faced in managing individual patients?

Every patient presents a unique challenge. For me, the most overarching issue is around the management of patients with multimorbidity. Clinical guidelines tell me how to manage asthma, hypertension, osteoarthritis in isolation yet I can't remember the last time I saw such a patient. As researchers we need to tackle this problem head-on, just as Prof Mercer (Glasgow) and Prof Salisbury (Bristol) are currently doing. It is also essential that we are alert to the presence of co-existing mental health problems, especially in patients with multiple chronic conditions. GPs are well aware of these challenges, although the way in which care is currently organised, and the increasing demand on services in primary care makes caring for our patients increasingly difficult.

You won a prize for 'best patient involvement in research, how does being involved in research benefit the patient?

Like many clinical academics, my research ideas are often triggered by patient encounters. A few years ago one of the patients who developed severe osteoarthritis at an early age was talking about how she would like to share her experiences of living with a chronic condition as she thought it might help other people. This resulted in a publication that won an award for best patient involvement, but more importantly it allowed my patient to express the challenges of living with osteoarthritis and the work which she seemed to enjoy having the opportunity to shape future research, and to really ensure that the research will impact on patient care. Without doubt having patient input helps to shape and improve all research studies.

Four years ago you won the Yvonne Carter Award for Innovative New Researcher, how has this benefitted your career?

Winning the Yvonne Carter Award really was a major stepping stone in my career. Not only did it provide me with the confidence to actively pursue a research career, it helped to open doors and provided me with a range of new opportunities. In particular, the funding received through this award allowed me to attend meetings that previously had no general practice representation. As such this has given me a real opportunity to influence the research agenda, in primary and secondary care. On a more personal level, Yvonne was an inspirational leader who always had time to support and mentor junior researchers. I've tried to learn from this and I have spent a lot of time trying to develop academic career pathways in general practice.

Are there opportunities for GPs to 'have a go' at the sort of research trials you do and what are the benefits?

Research activity and general practice are a perfect combination. This is a message the SAPC are currently promoting. Many GPs are already taking part in research by working in partnership with Clinical Research Networks across the country. Recruitment to clinical studies from primary care is phenomenal in demonstrating the clear interest GPs have in not only using the best evidence but also in helping to generate it. For GPs who want to get more involved there are a number of opportunities including the NIHR In-Practice Fellowship scheme which gives established GPs the chance to buy themselves out of clinical work for 2.5 days a week to gain formal research training and get involved in a research study. This can lead onto opportunities to study for a PhD and lead your own programme of work. University departments of general practice are always keen to work in partnership with local clinicians to help them shape research questions to ensure relevance to patients and practitioners. General practice is busier and more demanding than it has ever been and I'm sure for many the idea of taking on an additional role is not appealing. I find that by combining practice with research I enjoy both jobs more than I would do otherwise. Research skills are very transferable to clinical practice and having access to University resources and being able to go to conferences helps me keep up to date. Patients and GPs always challenge convention with questions such as 'why do I need to take this...?' and are a constant source of new and exciting research questions. I couldn't imagine doing one without the other.

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