The blind spot issue

As academics, we tend to believe that the readers of scientific journals receive information that is based only on quality of science. We even try to measure our scientific success objectively, with the impact factor and number of publications.

Nevertheless, the reality is often far from our expectations. Science suffers from ‘blind spots.’ We know that certain disciplines are receiving lower impact factors than the others, that certain health problems are less likely to be presented in scientific journals, that all the treatment options are not equally likely to be presented in the medical press and that there are regions and countries in the world whose experience is hardly ever being published. We see that most research is being published by high-tech specialities, on problems of the rich (1), by the researchers in the most developed part of the world (2–4). This in turn generates more money for this kind of research and higher impact factors of such journals. It is a vicious circle, as if the ‘inverse care law’ (5) is being reflected in science as ‘inverse publication law.’

General practice/family medicine has often been the underdog of the scientific community (6–8). We have struggled to be recognised as an academic discipline and to be recognised as a special scientific entity within the academic world (9). Only recently, the classification of medical terms has included »primary health care« as a separate entity (10).

Journals specialized in general practice/family medicine should support the specificities of that discipline, therefore, the mission of The European Journal of General Practice should be to avoid the ‘blind spots’ in general practice. We should give priority to research reflecting the core issues of general practice and not to studies that just are applications of other paradigms in general practice (11), as was clearly pointed out by the European Research Agenda (12).

The issue of inadequate representation of European regions in publishing scientific articles is still a very important one. Our readers have the right to know about the recent developments in health care in the UK and the Netherlands, but also about the ones in Georgia or Albania. We should be trying to avoid the false impression that nothing much is happening in the less developed world, and that the most of innovative approaches originate in the developed world.

In the last year, I have had an opportunity to be involved in a series of interesting developments in Eastern Europe that have not been published in any meaningful scientific journal.

• Hajduszoboszlo is a town many might find impossible to pronounce. The Hungarian association of departments of family medicine (CSAKOSZ) has held its annual conference there. However, the Hungarian hosts have made a further step: they have invited the heads of departments from Poland, Slovakia, Austria and Slovenia to attend the conference and to hold a session about international academic general practice in English. This experiment has proved to be successful: the room was full, there was a lot of interest and discussion and contrary to the popular belief, the knowledge of English was not an obstacle at all. Owing to this, an idea of establishing an association of departments of family medicine in Eastern Europe was created. The participants have signed a memorandum that is supporting this idea.

• In the last two years, I had a privilege of working in Macedonia, where the government has embarked on an ambitious project of implementing family medicine as the obligatory speciality in primary care. It has also decided that the entire health care system will be based on family medicine. This is an ambitious project, involving re-training of all existing primary care doctors towards proper family doctors and introducing a training scheme for family medicine that would be compatible with EU standards. In May this year, an historic event took place: the first group of doctors have finished their re-training and have passed the final exam, conducted by foreign examiners (Figure 1).

  Figure 1. The first group of doctors after they have passed the final exam of family medicine in Macedonia.

  

• Montenegro is one of the smallest independent countries in Europe. The government has developed a programme of re-training primary care teams to improve the quality of primary care. Through this programme, all primary care teams had to undergo a four month course on management of common problems in primary care. The programme will end this year, meaning that all primary care teams in the country will complete the re-training. This is a major achievement for a poor country, and the government has already decided to embark on a new project: an implementation of obligatory specialization of family medicine in primary care.

• Finally, in Slovenia, the government has decided—after many years of supporting hospital-based programmes—to invest in primary care. A programme of introducing nurse practitioners in primary care has started this April. So far, about 15% of all practices are taking part in this programme, with the ambition of gradually increasing this proportion in autumn and in 2012. Although the data are scarce at this point, the first results seem to be positive: the patients have accepted the new health care professionals very well and the teams seem to offer better services.

I am certain that these are only a few examples and that one could find interesting and ambitious projects elsewhere in the region (e.g. in Albania, Kosovo). I also know that even if these initiatives are interesting and potentially important, there are many obstacles ahead. Good ideas may be forgotten because of other priorities, and ministries may change their policies after the next election and come up with new plans. Nevertheless, this does not diminish the importance of changes that are taking place.

It is a pity for the scientific community that these exciting events are not reported in scientific journals, because they speak about the developments of the discipline in an important part of Europe. We know that the barriers to produce good reports are high: there is less research infrastructure, less expertise and less involvement of general practice in the scientific community than in more affluent countries; the experts that exist are fighting an uphill struggle to conduct research and get funded. Publication of their work in a high profile journal like The European Journal of General Practice is a major source of their support.

One of the missions of The European Journal of General Practice is to offer support to writers that are interested in reporting these kinds of achievements. This task is by no means easy for the editorial board. We have to balance the need of supporting authors from these countries in their efforts to publish and the need of maintaining adequate academic standards of the papers. This involves spending more editorial effort and time on coaching and supporting authors from less privileged parts of Europe. We are rewarded when we are able to present to our readers good papers from these areas. This is increasingly happening and it is a sign of development, not only of the regions, but also of the discipline itself.

Acknowledgements

I am grateful to Prof. Matko Marušić, the former editor of the Croatian Medical Journal, and Prof. Janko Kersnik, for their comments to the draft of this manuscript.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.