A young man came in to my surgery recently with a facial palsy. Worried, naturally, and with his wife in tow to make sure that he asked all the questions to which she wanted answers. It isn't often that I see Bell's palsy, now that I'm no longer a proper (that is, full-time) GP, but my partners reckon to see one every year or two and it is so characteristic that making the diagnosis was straightforward. Neurology is stuffed with eponymous syndromes and I admire the doctors who, more than two centuries ago, were able to work out what was going on in the nervous system. Personally, the skull has always seemed a bit of a black box. Charles Bell, who described this palsy of the seventh cranial nerve, was a surgeon who left Edinburgh for London in 1812 and took over Hunter's anatomy school in Windmill Street. Roy Porter describes him as the Crown Prince of Hunterian anatomy.1 In taking the English shilling, he also left behind a fellow anatomist, Robert Knox, whose burgeoning need for dissection cadavers infamously gave Burke and Hare their opening 15 years later.
I imagine that in his day, Bell had clear ideas about the most effective treatment of his palsy; surgeons are like that after all. My patient was no different, having been to the primary care centre, and then to his local pharmacy. The first had given him steroids; the second insisted he see me immediately to get an antiviral. The sense of urgency was palpable, as was the concern about whether he would recover. They wanted me to respond there and then, decisively and accurately. My problem was that I hadn't seen a case for several years.
That's when you appreciate the clear, reliable and memorable messages that good research can bring. In this case it was an elegantly designed and well-conducted primary care trial published in the New England Journal of Medicine. I changed the steroid regime to 25 mg twice daily for 10 days, told him that adding an antiviral would make no difference to his outcome and that there was an 83% likelihood he would be fully recovered at 3 months, rising to 95% at 9 months.2
The Research Paper of the Year looks for studies that are methodologically excellent, may have been challenging to do and address an important question for practising GPs. If they can tick all those boxes, and also deliver a clear and memorable message, they are on the shortlist. This year's winner does all of that. And my patient is very grateful.
- © British Journal of General Practice, 2008.
