Integrating science and practice: Reclaiming the science in practice

This article is intended to be somewhat provocative, stimulating discussion in our efforts to better integrate science and practice. Three major areas of divisiveness between science and practice are posited-understanding of practitioners' approach to practice, definition of scholarship, and the role of theory and diagnosis in practice. Some general principles are offered that may further our thinking about integration of the applications of science in the practice of psychology and the participation of practitioners in science: (a) all practitioners do evidence-based practice; (b) scholarship has many forms, each of which provides an important piece of the puzzle of advancing knowledge; and (c) "eclectic" is a theoretically and practically meaningful term.     

Specialization in general practice

Ideas about general practitioner specialism may have been hampered in the past because of the three models of general practitioner specialism — in the hospital service, the fee-earning specialoid or the general practitioner obstetrician — none of which is satisfactory.

However, general practitioner specialism can be justified in guaranteeing standards by concentrating groups of patients, accepting responsibility, and planning care. Medico-political changes may be needed to achieve improvement in clinical standards.

     

Interruptions in general practice

Twenty routine General Practice surgeries were studied in an Irish urban setting by 2 independent observers. There were 212 observed consultations and 53 (25%) were interrupted. Of this 53 there were 80 interruptions in total, 32 (40%) of which were significant. The commonest source of interruption was the telephone (50%). This was followed by interruptions from the door, the patient's mobile phone, and the doctor being required to leave the room.     

Physiotherapy in general practice

Approximately nine per cent of all episodes and of all consultations in this practice during a two-year period were for musculo-skeletal disorders. Absence of ready access to hospital physiotherapy departments stimulated us to explore the possibilities of organising a private physiotherapy service.

A scheme has now been in operation for over two years in which a physiotherapist treats patients on the practice premises. In this way it has been possible to provide prompt effective treatment at about one third of normal private physiotherapy charges. The scheme has succeeded from the points of view of therapeutic efficacy, of convenience to patients, to doctors and to physiotherapist, and of economy. The range of conditions treated and the results of treatment are described.