Interaction between research, education and practice will uplift Primary Care
Family Medicine trainees should view the patient not only as a person who needs medical help, but also as an opportunity to exercise a scientific question. With a stronger basis in research a Family Doctor will have a broader scope of answers to the needs of patients. “Good research with good evidence produces better students who then become better Family Doctors. My ultimate aim is to educate academic Family Doctors.”
This is the heartfelt conviction of Jean Muris, who has been appointed as Professor of Asthma and COPD in Primary Care in September 2014. He will deliver his inaugural lecture on 25 September 2015. Jean Muris is currently Head of Maastricht University’s Family Medicine Specialty Training Programme. He is passionate about the importance of interaction between scientific research, education and healthcare. But he is not convinced of the overreliance on science, especially in chronic disease. The communication between doctor and patient and the needs of the patient should get more emphasis.
“My trainees should look at implementing their scientific knowledge into their day to day work with patients,” says Muris. “For example, one of my students conducted a scientific experiment with a CRP (C-reactive protein) test, using a droplet of blood from a finger prick. His assumption was that if the droplet showed a very high level of CRP this would point to a bacterial infection, so the patient would need antibiotics. This CRP test has already proven to be a very useful tool in daily practice.”
After graduating at Maastricht University, Muris (1959) acquired expertise in an academic practice in Venlo (Health Care Centre ‘Withuis’) during 7 years and after that in a rural academic practice in Geulle, a little village of around 3000 inhabitants, where he still practices. He obtained his PhD with a thesis on chronic abdominal complaints (irritable bowel syndrome), although early on in his studies he specialised in chronic respiratory diseases (asthma and Chronic Obstructive Pulmonary Disease).
In 2010, Muris became Director of Family Medicine Specialty Training. Here 240 trainees are trained in 200 practices in the Provinces Limburg and Northern Brabant. “My trainees are able to think academically. We train them in critical appraisal. Let’s say you have a patient with a cardiovascular disease, I ask them: Should you give him certain medication? Try to establish first: what are the actual needs of this patient at this point in time? Phrase your question, establish his need. What is the evidence of the medication, what is the evidence of doing nothing? Search in the literature. Then talk to your trainer and learn from his or her practical knowledge, clinical expertise and experience. Then try to apply the answers to the case that the patient presents using shared decision making.”
“Everything begins and ends with the patient,” says Muris, quoting David Sackett, a pioneer in evidence-based medicine (EBM). “Of course, not everything has been researched and the evidence by itself cannot make a decision for you, but it will help you in the patient care process. You have to take your practical knowledge, experience and gut feelings into account as well. Muris hopes that his Chair will ultimately uplift the level of healthcare in the region. “Apart from my aim to educate academic Family Doctors, it’s my ambition to connect primary and secondary health care. I really want to bring in specialists into the Family practice and connect Family Doctors with specialised care, using knowledge from different disciplines.”
Nowadays a Primary Care practice needs specialised input, says Muris. “Patients are becoming more and more knowledgeable. Even in a little village like Geulle they first consult Dr Google before they see me. They sometimes have high expectations, but they also tend to derive in the direction of care that is not evidence-based. That’s why the Dutch College of Family Doctors (NHG) has made an app for patients (www.thuisarts.nl) where they can find evidence-based underpinning usable in the doctor-patient consultation and why more family doctors should further train and differentiate after graduation.