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What I Learned; What Will You Discover?

The Annals online discussion (called TRACK) interprets, questions and challenges the findings of articles published in the Annals from the perspectives of diverse readers. In this On TRACK, I reflect on what the online discussion since the last issue has taught me, and invite you to reflect on your own revelations.

What I Better Appreciate

• The rejuvenating potential of bringing an ecological perspective into the consultation room in small ways,¹ and the challenges of doing so^2,3
  
• The complexity and implications of interpersonal continuity of care^4–6
  
• That people "yearn for a PHYSICIAN who will get to know them and STICK WITH THEM as they reap the benefits of modern medicine applied to their worries, problems and personal health care goals. But they don’t think this type of physician exists anymore, and if such a physician should be fortuitously discovered, people doubt that the current ridiculous health care arrangements in the United States do or would permit them to do their job as a personal physician."⁷
  
• That despite all the guidelines and emphasis on prevention and chronic disease management, "The prize of office care is attending to the chief complaint, understanding it and seeing it in the context of the patient’s life."⁸
  
• The largely untapped but rapidly emerging potential of community-based participatory research for addressing some of our most intractable problems^9,10
  

What I Understand

• The need for more primary care clinicians to perform colonoscopy,¹¹ and the feasibility of adding this skill to practice with a high degree of competence^12,13
  
• The potential and limitations of unsedated ultra-thin esophogoscopy for screening and diagnosis of the airway, esophagus, and upper stomach^14,15
  
• The "multifaceted nature of many mental health problems and the need for complex integrated strategies to deal with them"¹⁶
  
• How the hard-won wisdom of painful personal experience can help clinicians to overcome a "warrior" mentality to develop more mutually healing connections with patients¹⁷
  

What I Grapple With

• The corrupting influence of pharmaceutical companies’ marketing^18–21 and our professional organizations’ dependence on it²²
  
• The difficulty of an intelligent, accomplished reader in grasping the complexity of research articles that we publish.²³ The Issue in Brief feature, accessible from the Annals homepage at http://www.AnnFamMed.org, is an attempt to put complex research articles into context and to make the main findings accessible to a broad audience. The discussant’s call for clear, accessible writing in the primary article, however, is a good reminder for authors and editors
  
• The need to move beyond reductionist and mechanistic thinking to fully make use of the wisdom in the biopsychosocial model²⁴
  

What I Learned About

• Successful efforts to increase communication between complementary and alternative and traditional clinicians²⁵
  
• Three categories of research: fundamental, strategic/developmental, and evaluative²⁶
  

Useful Web Sites I Found

• Avoid being bought by pharmaceutical companies at: http://www.NoFreeLunch.org¹⁸
  • Community participatory research^9,10
    • AHRQ Evidence Report "Community Based Participatory Research": http://www.ahrq.gov/clinic/tp/cbprtp.htm
      
    • NIEHS Community-Based Participatory Research: http://www.niehs.nih.gov/translat/cbpr/cbpr.htm
      
    • Community Participation in Research (PAR-05-026): http://grants.nih.gov/grants/guide/pa-files/PAR-05-026.html
      
    • NCMHD Community Participation in Health Disparities Intervention Research (RFA-MD-05-002): http://grants.nih.gov/grants/guide/rfa-files/RFA-MD-05-002.html
      
    
    
  
  

I’m Looking Forward to Authors’ Replies to These Concerns

• The association of transferrin saturation, dietary iron intake and cancer risk²⁷
  
• How researchers studying cognitive strategies of physicians figuratively got into the heads of their study participants²⁸
  
• The analysis methods of a study of patients not accepting the diagnosis of depression (questions raised by medical students using the article for a journal club)²⁹
  

This is my personal list of learning from the recent online discussion of the Annals community. What is yours? Please join these and other readers in adding your insights at http://www.annfammed.org. Click on "Discussion of articles" or follow the links for the comments or the article on which you wish to comment.

REFERENCES

1. Gilbert A. With creativity we find ways to make a difference [eletter]. http://www.annfammed.org/cgi/eletters/3/2/173#1696, 17 April 17 2005.
2. Laughery RM. Prevention and greed [eletter]. http://www.annfammed.org/cgi/eletters/3/2/173#1688, 12 April 2005.
3. Fagnan LJ. Don’t I have enough to do [eletter]. http://www.annfammed.org/cgi/eletters/3/2/173#1667, 4 April 2005.
4. Freeman GK. Still not quite there with definition? - but the challenge is to measure ‘interpersonal’ and show it makes a difference [eletter]. http://www.annfammed.org/cgi/eletters/3/2/159#1699, 21 April 2005.
5. Bayliss EA. Can a village care for a patient? [eletter]. http://www.annfammed.org/cgi/eletters/3/2/159#1692, 13 April 2005.
6. Litaker DG. The importance of continuity of care: are we asking the wrong questions? [eletter]. http://www.annfammed.org/cgi/elet-ters/3/2/159#1645, 30 March 2005.
7. Green LA. Reframing continuity [eletter]. http://www.annfammed.org/cgi/eletters/3/2/159#1682, 9 April 2005.
8. Stephens GG. Competing for the doctor’s attention [eletter]. http://www.annfammed.org/cgi/eletters/3/2/144#1653, 2 April 2005.
9. Meyers DS. CBPR and PBRNs: Methodologies for exploring primary care [eletter]. http://www.annfammed.org/cgi/eletters/3/1/70#1610, 23 February 2005.
10. Macaulay AC. Recommended reading in community-based participatory research [eletter]. http://www.annfammed.org/cgi/eletters/3/1/70#1597, 21 February 2005.
11. Ramakrishnan K. Colorectal cancer screening by family physicians [eletter]. http://www.annfammed.org/cgi/eletters/3/2/122#1676, 8 April 2005.
12. Leer LR. Outpatient colonoscopy [eletter]. http://www.annfammed.org/cgi/eletters/3/2/122#1658, 8 April 2005.
13. Pfenninger JL. Great results on office colonoscopy [eletter]. http://www.annfammed.org/cgi/eletters/3/2/122#1647, 30 March 2005.
14. Ramakrishnan K. Office-based unsedated ultrathin esophagoscopy [eletter]. http://www.annfammed.org/cgi/eletters/3/2/126#1651, 31 March 2005.
15. Chak A. Comment on Wilkins et al [eletter]. http://www.annfammed.org/cgi/eletters/3/2/126#1640, 30 March 2005.
16. Thomas PR. Depression is not one thing [eletter]. http://www.annfammed.org/cgi/eletters/3/1/31#1624, 9 March 2005.
17. Clabby JF. The physician as warrior [eletter]. http://www.annfammed.org/cgi/eletters/2/2/175#1627, 17 March 2005.
18. Silverberg LI. Will we ever resolve this issue? [eletter]. http://www.annfammed.org/cgi/eletters/3/2/177#1686, 11 April 2005.
19. Little JR. When a doctor is the rep [eletter]. http://www.annfammed.org/cgi/eletters/3/1/82#1690, 12 April 2005.
20. Alpart AS. Samples and gifts [eletter]. http://www.annfammed.org/cgi/eletters/3/1/82#1633 28 March 2005.
21. Blossom HJ. My vituperation [eletter]. http://www.annfammed.org/cgi/eletters/3/1/82#1619, 6 March 2005.
22. Leer LR. Surviving on the largess of big pharma [eletter]. http://www.annfammed.org/cgi/eletters/3/1/82#1661, 3 April 2005.
23. Modi S. Help me understand [eletter]. http://www.annfammed.org/cgi/eletters/2/6/555#1617, 4 March 2005.
24. Tizon JL. Epistemology, politics, emotions and counter transference: around "The Biopsychosocial Model 25 Years Later: Principles, Practice and Scientific Inquiry" [eletter]. http://www.annfammed.org/cgi/eletters/2/6/576#1631, 17 March 2005.
25. Schiff E, et al. Invited commentary from Dr. Schiff and Dr. Ben-Arye [eletter]. http://www.annfammed.org/cgi/eletters/3/2/151#1656, 3 April 2005.
26. Martin CM. Strengthening family medicine research [eletter]. http://www.annfammed.org/cgi/eletters/2/suppl_2/s5#1599, 21 February 2005.
27. Cohrssen A. Dietary iron - was it fully assessed? Why was it taken? [eletter]. http://www.annfammed.org/cgi/eletters/3/2/131#1672, 5 April 2005.
28. Hamm RM. Wonderful and wonderable [eletter]. http://www.annfammed.org/cgi/eletters/3/2/144#1669, 4 April 2005.
29. Chao J. Questions about the data analysis [eletter]. http://www.annfammed.org/cgi/eletters/3/1/38#1678, 8 April 2005.

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