Clinical practice and medical research: bridging the divide between the two cultures

The failure of the results of many research studies to be integrated into everyday clinical practice is both well documented and much decried. In the writings on why medical research and clinical practice have remained separate cultures, two issues have not been sufficiently debated. First, are medical researchers addressing the problems that cause clinicians the most concern in their consultations with patients, and secondly, are the results of research studies being presented in a manner that clinicians can both understand and use? This discussion paper highlights primary care clinicians' urgent need for information on the predictive value of the symptoms and signs seen in everyday clinical practice. Medical research has still to provide this information, often leaving general practitioners with inadequate predictive information on which to make early diagnoses, for example, on whether a patient with chest pain has a pulmonary embolus, or a child with pyrexia and rash has meningococcal septicaemia. The format in which research information is commonly presented is discussed; it has been shown that epidemiological terms used in studies are impenetrable to most clinicians. Additional ways of framing research information need to be devised that present such research information in a narrative format and numerical format, emphasizing the effects of management decisions as well as diagnostic categories, and for use in individual consultations as well as describing populations. Only then will clinicians be able to integrate into their everyday clinical practice the potentially valuable information provided by medical research.