How many papers presented at conferences reach publication? How many small studies completed for higher degrees never reach peer reviewed literature? Do they have important messages we can use in our professional lives?
I often reflect on these questions while commuting to and from work and considering how to disseminate the small-scale studies I am involved in as a medical educator.
A senior professorial colleague brought these ruminations into sharp focus recently. The conversation went roughly as follows: ‘Did you present a paper at SAPC a long time ago about refugees?’ ‘Yes’, I replied, ‘A decade ago … it was my masters … I never got round to publishing it’. ‘Well ...’ he said, ‘it changed my practice’. And then went on to clearly identify the key points of my masters dissertation and how he currently used them in consultations.
This stopped me in my tracks. I was stunned. I had done something that had influenced someone who I didn’t know at that time. He had listened to my 10-minute short oral presentation at the Society for Academic Primary Care and turned the results into actions within his practice that still had relevance 10 years down the line.
I am a GP and run an undergraduate clinical skills programme, so aim to influence behaviours in my daily life, but the concept of a piece of research completed a long time ago currently influencing a senior colleague was a different matter. Publication at that time for me was the territory of the professional researcher, not a fledgling GP considering how to progress their career while juggling life. Other things got in the way and I never published the study.
BRIEF SUMMARY OF THE STUDY
Background
In 2002 as part of my masters in primary care dissertation, I completed a study about access to primary care for refugees and asylum seekers. The aim was to identify how the initial point of contact could be improved in the health economy I was working in at the time; Barking and Dagenham in Essex. I received a small grant from the Claire Wand Fund1 and ethical approval from the local research ethics committee.
METHOD
I convened three focus groups with refugees and asylum seekers in their own languages using interpreters, translated the data into English using the same interpreters, and analysed the results using the Framework technique.2 I then completed 15 interviews with local GPs and practice staff. Again this was analysed using the Framework technique.
RESULTS AND DISCUSSION
The participants included Albanian-speaking and African French-speaking refugees and asylum seekers, from established communities in Barking and Dagenham.
The main themes that emerged were about the divergent perspectives of the health professionals and those groups of refugees and asylum seekers and how these differences led to frustration and conflict in consultations. One of the key themes identified was that these individuals were used to managing risk in their lives. This involved attempting to exert control over their interactions with the agents of health care to try to manage these interactions in the way they would have done, prior to coming to the UK.
Their previous experiences often involved purchasing health care and so the UK health system, where care is free at the point of delivery, presented them with challenges that the healthcare teams did not understand. The refugees and asylum seekers perceived stigma and risk in some primary care consultations where no referral to secondary care was made or no prescription issued. This lack of action was viewed as a reflection of their status rather than management in the patient’s interest and confrontation often followed. When these views were explored and reassurance offered, the tensions frequently resolved. This highlighted the role of communication skills in exploring others’ perspectives and negotiating a solution.
How much other untapped work is available that we cannot access via an internet search? How many small nuggets of work completed for personal development have the power to influence others and benefit patient interactions?
I do not presume to offer an answer but hopefully to inspire individuals who have completed or are completing a masters, to consider disseminating their research so that all those hours of work have the possibility of impacting on someone beyond themselves.
REFLECTION FROM THE ‘SENIOR’ COLLEAGUE
The results of this study represented a personal ‘eureka’ moment. Suddenly it was obvious why so many consultations with new arrivals were so confrontational: in their eyes, I was denying them the care, which everyone else received. For me, the paper had a deep and suddenly obvious truth. The changes in my practice were simple:
explain to those whose previous health care experience had been outside the UK that there are many conditions for which the appropriate and evidence-based care is watchful waiting;
that is why I am suggesting ‘do nothing’; and most importantly
this would be the case for everyone.
Consultations with new arrivals did not become easy but certainly became easier.
I have always felt that we have insufficient feedback from peers, seniors, and juniors. It took me a while to work out that my new colleague was indeed the author of the neat little paper I had heard many years ago which had caused me to reflect on the challenges of working in a multicultural practice with many new arrivals. Having worked this out, I thought it appropriate to tell her; after all, I am pleased when someone says that they know of and use my work.
I am somewhat surprised and gratified by the impact. I would encourage others to do the same: tell people if they or their work has made an impact. Good things will come of it.
Acknowledgments
Professor Martin Underwood and Dr Geoff Harding who supervised the project.
- © British Journal of General Practice 2013