The vast majority of general practitioners in the Netherlands have no direct access to academic medical publications, such as case studies or research. Making materials available to GPs via Open Access would be a viable solution, both from a cost-cutting and professionalism perspective. Jean Muris, Professor and Chair of the Department of Family Medicine at Maastricht University, argues that this should be accompanied by use of open access search systems.
The Professor of Family Medicine is also calling for access to a good search engine
“Publications via Open Access available for all general practitioners”
Only one in five general practitioners in the Netherlands, out of a total of approx. 10,000, have a formal affiliation with a university medical centre. The lion’s share of that group, in addition to their work as a GP, work part time teaching at one of the academic centres. The remaining share of the group consists of ‘staff doctors’ (Dutch: kaderartsen), who specialise in a certain field, such as gerontology, within their practice, and in that way are directly involved in the academic community.
“Those general practitioners have direct access to hundreds of scientific publications, either physical or digital, by way of the subscriptions of the university libraries. They have access to the most recent patient studies, to doctoral research, clinical studies, reflections, and new insights. All absolutely essential resources to a GP, in my opinion, and, really, that material should be available to each and every GP in the country.”
Fact of the matter is that although those materials are, indeed, available to every GP, many of the corresponding subscriptions are expensive and the extensive variety of publications makes selection a difficult process. “At our General medical practice programme in Maastricht, there is a great deal of focus on the relevant media and publications,” says Muris. “As a department, we make choices based upon which the University Library purchases subscriptions and licenses. In order to be able to find the right articles in the extensive collection that we then have, we teach trainee GPs searching skills. That collection cannot be accessed by GP graduates who are independent and have no academic affiliation, who are then primarily constrained to using the limited information available on the internet for free.”
The professor, who is himself an experienced GP, is quick to dismiss the inference that those doctors do not keep their skills and knowledge up to date. “That has nothing to do with it,” he says, heaving two substantial volumes onto the table. The “bible”, containing a detailed description of 108 different pathologies, which are constantly revised. “It’s a standard publication, but not every patient fits the mould. They don’t all fit within the prescribed frameworks. As a GP, when faced with certain clinical pictures or symptoms, you really just want to hear a colleague’s opinion. Or you’d like to consult the recent studies or research on the matter. In those cases, having access to the right information is such a pleasure. And if those publications are available on Open Access, that can be a big help.”
In a broader perspective, providing access to scientific information to general practitioners can also be regarded as an instrument to cut costs in the health care sector. Muris continues, saying that, “information helps you when making a diagnosis. A GP in doubt is more likely to refer a patient to the hospital. Our priority, however, is to ensure that primary care handles more cases. Specialist and more expensive care are intended for more serious cases. In this way, Open Access can contribute to cutting costs and can connect GP practices to information they can use in the workplace.”
The professor, who has had a general practice in Geulle, Zuid-Limburg, for over 30 years, warns that simply “opening up” all the resources to everyone would not be enough. “A good search engine with the appropriate filters would be worth its weight in gold. You might compare it to the search system on a holiday booking site: eventually you end up with the best options. The average GP sees between 25 and 30 patients every day. In between or after practice hours, he might spend time searching for more information on a certain case. Not nearly all search systems are openly accessible to everyone. For that reason, they would also have to be Open Access, and geared more toward general practitioners. That would, no doubt, save a lot of time. It might be a prudent idea to raise this issue with the relevant publishing houses and libraries.”