THE PERSONAL FACE OF PRIMARY CARE RESEARCH ========================================== * David Katerndahl *David Katerndahl, NAPCRG’s 2011 Wood Award winner, reflects on the personal impact of primary care research on not only patient’s lives, but the lives of those participating in the research and primary care research investigators as well. In the following essay, Katerndahl shares some personal experiences with this as he shared when accepting the Wood award at the NAP-CRG Annual Meeting in November 2011.* Does our research really make a difference? Most of us chose a life in primary care because we wanted to make a difference in people’s lives. I once calculated the potential impact of a research study published in a primary care journal1. For example, with a monthly rate of 100,000 online hits and assuming that two thirds of those are from providers, an article on depression published in *Annals of Family Medicine* could potentially affect the care of 1 million depressed patients over the subsequent year. In addition, such an article affects the faculty reading the article who teach, on average, more than 7 family medicine residency graduates each year as well as the more than 4 researchers who subsequently cite it. Thus, in 1 year, a well-read article can potentially affect the care of 70 times as many patients as seen by a practitioner in his/her lifetime. But the impact of our research has, in fact, a personal face, reaching far beyond such abstract numbers. In fact, is impact-free research possible? Or does the reactive arrangement that we call “the research design” necessitate change? Indeed, even non-interventional research has the potential to evoke unforeseen effects in those who participate. Early on, the focus of my research was panic disorder and, although a skeptical collaborator believed that I was “studying something that didn’t exist”, the research subjects, trapped within their homes, often expressed relief when discussing their anxiety, social fears and limitations. When we almost inadvertently discovered a history of childhood sexual abuse, these women would often burst into tears, stating that this was the “first time they had disclosed this trauma to anyone.” Although this was a source of concern for human subjects review committees, these women uniformly made such disclosures with a sense of relief. But personal impact goes beyond a simple unburdening; it can literally change lives. Even among women in violent relationships who intended to remain with their abusive partners, study participation frequently affected change, convincing women to leave the relationship.2 These women often told us that, through the study, they gained insight and felt empowered. One woman’s story was particularly dramatic. During the course of the study, this young woman who had been verbally and physically abused for more than a year told us that her daughter was also being victimized, but requested that we not report it. Legally, we had no choice but to inform Child Protective Services. For a week, we heard nothing from her despite our efforts to make contact. When we finally did, instead of being angry with us, she told us that within a week of our report, caseworkers had forced the violent spouse and father to vacate, causing the woman to say that “participating in our study was the best thing that had ever happened to her.” But our research affects more than our subjects; it potentially affects our readers as well. Last spring, we published an article about the complexity of primary care practice, comparing it with that of ambulatory cardiology and psychiatry.3 Although pleased with its acceptance by editors, we were surprised when a frustrated and besieged practitioner thanked us and wrote that the article had “inspired him in a way he hadn’t known” before. But our research can influence more than its subjects and consumers; the impact can strike even closer to home. A research assistant involved in our domestic violence agenda recently shared her story with me. Initially hesitant to work on our project, she found that, once involved, she was changed by the training she received and the personal stories that she heard from the subjects. Living in a marriage characterized by verbal abuse and distance, she had been contemplating divorce. But as she grew during the study, she confronted her husband, promoting both her self-esteem and his self-disclosure of childhood trauma. Consequently, they are now in counseling and attend domestic violence conferences together, joined in a commitment to their relationship and an end to the cycle of male-perpetrated violence in his family. In addition, through the sharing of the stories of our subjects, her emotionally-distant mother has shared her untold story of sexual assault. But such tales of personal healing, while often unacknowledged, are not all. Ultimately, our research affects us, its investigators. You cannot listen to a tearful woman share her formerly untold story of sexual abuse or social terror without being moved in response. Only the most hardened investigators could learn of the healing evoked by their study without being changed. Research is a social activity in which all who participate, researcher included, can be transformed. I know I have been. As quantum physicists know, you cannot study an atom without affecting it, whether that atom is in a particle accelerator or the human brain. Every time we measure, we alter. Each perturbation ripples out, affecting all of those involved. Our research has the potential to personally impact each subject, each reader, each member of the research team. As researchers, we serve as change agents, while becoming changed agents. Primary care is all about making a difference and that is no less true of our research than it is of our patient care or teaching. Often the impact of our research is very personal. We make a difference when we offer a research subject insight and validation, and when we listen to her story and allow ourselves to be changed. We make a difference in that moment of shared discovery. We make a difference when we provide a word of encouragement to a resident to submit an abstract to NAPCRG or critique a colleague’s manuscript. Research is a social activity in which all who participate can be transformed. Making a difference; that’s easy, we do it all the time! * © 2012 Annals of Family Medicine, Inc. ## References 1. Katerndahl D. Family medicine clinicians, teachers, and researchers touching patients’ lives. Fam Med. 2003;35(5):365–366. [PubMed](http://www.annfammed.org/lookup/external-ref?access_num=12772940&link_type=MED&atom=%2Fannalsfm%2F10%2F2%2F174.2.atom) 2. Tinitigan M, Becho J, Burge SK, Ferrer RL, Wood R, Katerndahl DA (2010) “Serendipitous intervention” among women experiencing intimate partner violence. Fam Med. 42(Supp2). 3. Katerndahl DA, Wood R, Jaén CR. Family medicine outpatient encounters are more complex than those of cardiology and psychiatry. J Am Board Fam Med. 2011;24(1):6–15. 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