often good ideas or new areas of research, which am not in vogue, cannot be pursued for lack of investment. Although this is a problem within all lines of research, some subjects can be hit harder than others, especially if it is not orthodox or currently appreciated by the governing bodies (such as in complementary medicine). The Foundation for Chiropractic Education and Research (FCER) has recently (in 1991) evaluated the position of chiropractic research with respect to the United States Government’s policies for funding. The FCHR’s views paralleled those expressed by Dr Dannenbring, namely that practitioners should link into ongoing research with some successful ‘name’ who can attract investment. The author shows a lack of research in certain areas, relying on emotive statements to carry the text over apparent weaknesses in the literature. He states that psychological research is rarely found in the chiropractic literature and that chiropractic research is ‘never found’ in the psychologic or medical literature. This is plainly not the case as the study by the Medical Research Council on chiropractic would indicate. The explanation for this statement, which may appeal to the more isolationist or paranoiac, hangs on the method of deciding where to publish. Such decisions are usually made on the basis of which journal has the most appropriate audience and the highest prestige value. Therefore, any medical or psycho logy researcher would not contemplate a small, and to them, low prestige journal such as JMPT with its limited audience. Solving this problem would appear to be the onus of the chiropractors (or complementary practitioners) who should attempt to publish their research in the more ‘mainstream’ medical journals, or at least those journals with a wider readership. This is difficult, even for the ‘professionals’ but can be much more rewarding for both the researcher and the profession! Furthermore, there are many people who, if asked, will offer help at all stages of research from the design of the project through to publication. The conclusions of Dannenbring’s article urge chiropractic researchers to investigate all potential avenues for funding and collaborative work with established researchers. Although it is laudable to help direct research into areas of funding, it may detract from the ultimate enjoyment. Research and development are usually driven by a need to know based on interest and motivation which as a British scientist I see as the principles of research. However, in these times of funding difficulty a conservative approach is being adopted, which is determinedmore by having a guaranteed outcome than by the above principles. Therefore, the reason for entering research can be seen as an important determinant in deciding the way to go. If you are motivated to follow something out of interest then you may have problems acquiring funds, but will find people to help. However, if your career progression relies on having done some research then no doubt the best advice is to follow the call of the big bucks, join an established group and develop your interest as you go.
Peter W. McCarthy PhD Senior Lecturer in Basic Science and active researcher Anglo-European College of Chiropractic Bournemouth, Dorset, UK
Sawyer CE, Kassak K. Patient satisfactionwith J Manip Physiol Tier 1993; 16(1):25-32.
Medical audit is a routine and systematic part of medical care and a required activity of every doctor in the National Health Service (NHS) in the UK. In establishing audit within the NHS the Government agreed with the principle that a doctor’s work can properly be examined only by fellow doctors.’ These issues are relevant to health care providers of all disciplines worldwide and it is interesting to note that studies are being undertaken by chiropractors without the explicit direction of Government bodies as the profession largely remains outside any Government supported health services. There are many dimensions to the efficient and effective delivery of healthcare services with one of the elements essential in assessing uality of care being the evaluation 9 of patient satisfaction. Providers can improve their services by appreciating how their patients view such issues as accessibility of the doctor, financial concerns and the conduct of the provider. This American study’s aim was to determine the attitudes of patients regarding the process and result of chiropractic care and to identify patient characteristics which might predict satisfaction. The questionnaire survey was extensive and achieved a response rate of 69.5%. Results are presented with extensive tables and variables in the study are explored for response bias. Patients were found to express high levels of satisfaction with their chiropractors and the care they received. Fairly predictably, those patients who reported little or no improvement in their health problem had a slightly higher degree of dissatisfaction as did those who found the financial aspects of treatment to be a burden. The limitations of the sample do leave further areas which need to be explored both in areas of audit and research. However, the authors of this study have made a useful contribution towards the evaluation of quality of care. In the increasingly competitive environment of health care provision and the general trends to accountability, consumerism and the patient’s right to choice, such studies will be essential for the renewal and survival of healthcare organisations both large and small. Susan
King DC, MBS Senior Lecturer
College of Chiropractic Bournemouth, Dorset, UK
References 1. Bull
AR. Audit: what is it and why? Curr Octhop 1993; 7: 171-174.
2. Maxwell RJ. Quality assessment in health. 1470-1472.
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