Research in general practice--achievements in the past and possibilities for the future.

It is a great privilege to be asked to formulate some thoughts on research in general practice on this very special occasion, the 25th anniversary of the founding of the Research Unit of General Practice. It is also a privilege to mark the retirement of a particularly distinguished researcher in Denmark, Poul A. Pedersen, a man who has emerged across Europe as one of the research leaders. There have been many links between Denmark and Britain, and in the 1970s I met and greatly admired Flemming Frølund and, more recently, Frede Olesen, Honorary Fellow of the Royal College of General Practitioners, and the past President of WONCA Europe, a great Ž gure for uniting general practice across Europe. The Ž rst Postgraduate Department (now Institute) of General Practice in the United Kingdom was started in Exeter in 1973 and was followed within only 6 months by the corresponding institute in Denmark, so I have followed developments in Denmark with great interest. My background is that I have worked as a general practitioner (GP) in the same practice for more than 38 years. I am the son, the nephew, the grandson and the father of GPs, so if there is a general practice gene, I think I must have it! My practice has 6,000 patients and Ž ve partners. I work part-time in the practice and part-time as Professor of General Practice at the University of Exeter. The paper will look brie y at the achievements of general practice in the past and speculate, which is all that can be done, about the directions general practice may take in the future. General practice research actually had its beginnings in the late 18th century, and it is perhaps salutary to remember that our forefathers made discoveries of international signiŽ cance through general practice research. In the United Kingdom in the 1790s, crucial early experiments on smallpox were made by Jenner (1) which ultimately led to the eradication of the disease that had been a scourge of society. In 1841, near Exeter, Budd, working in a single-handed rural general practice, discovered the difference between typhoid fever and typhus (2). In the late 1890s, Sir James Mackenzie (3) discovered ways of measuring the rhythm of the heart, which was the forerunner of the ECG machine and what we now know about cardiac rhythms. A Ž nal example is William Pickles (4), who, in the 1930s, began to chart the pattern of infectious disease. A common feature of all these men is that they were single-handed GPs, working in one practice, concentrating essentially on one group of problems. They were able to make truly world-class research contributions . The organisationa l basis of general practice as it is today was laid in the middle of the 20th century with the establishment of Colleges and Academies of General Practice, starting in the USA in 1947; the Ž rst in Europe was the Royal College of General Practitioners in England in 1952, followed by colleges in Denmark and other countries throughout Europe. More recently, these academies, colleges or societies grouped together to become WONCA. At present in the United Kingdom, there are now 60 professors of general practice, there are formal training programmes and research programmes, and there is more research in universitie s and in general practices than ever before. In my own region of the South-West of England, we now have £1,000,000 underpinning research in general practice outside the universities. There is some disagreement among historians about when the discipline of general practice emerged as a scientiŽ c discipline, but it was around 1961. This was when the body of knowledge became formalized and published and it was possible to identify general medical practice and family medicine as a speciŽ c scientiŽ c discipline . From then on, its development can be followed, and I suggest that that development was essentially the assimilation of an ever-wider number of other disciplines , which have enriched and informed the ideas of family doctors. In Britain, this started in the 1950s with psychiatry or psychotherapy. A Hungarian, Michael Balint (5), wrote a particularly important book using Hungarian psychotherapeutic insights, and really opened up the rich Ž eld of the doctor –patient relationship . At about the same time, Logan and Cushion (6), with their work on epidemi-