No 78 - A Timeline of General Practice and EBM: In Much More Detail
tldr
This post includes a very detailed timeline on the development of General Practice and Evidence Based Medicine. I also explain why we developed it and why we had to cut so much of it out to fit it onto a poster.
Two questions for you, dear reader:
1 - Are we missing anything important? If so, please let me know.
2 - Would you use this timeline as part of an introduction to GP training or medical school?
linktr.ee/jakemat91-for all of my work and articles
Introduction - Why am I writing about this?
Weirdly, I have had an interest in medical history well before I started medical training. Like many young men, I was first fascinated by the ancient Greek myths and histories. You can’t read much about Greek history before discovering Hippocrates and philosophers. And from there, it is easy to develop a keen interest in the rest of Western Medicine.
I can still remember writing my medical school application personal statement and referencing the following books:
The Rise And Fall Of Modern Medicine by James Le Fanu
Then, all of the way through medical school and up until now, I have always tried to dig into a subject and read about it’s history. Mostly, because I find it interesting but also because I find understanding the story helps me remember more about the drug/treatment.
Recent Work on the History of Medicine
Over the last 2 years I have spent quite a bit of time reading and thinking about medical history. Some of you may have read some of these posts before:
The History of Medical Officers' Training in the British Army
No 77 - The Art and Science of UK GP: A Historical Timeline
No 36 - Searching for the ideal history of EBM and medications
No 37 - My plan for learning the history of modern medications
No 22: A Global Health Challenge: why does everyone treat everything differently?
No 38: Factfulness by Hans Rosling - key points
No 46 - Diabetes: A deep dive into the history of diagnosis and treatment
No 47 - The Big Business of Obesity
No 49: Hypertension, Blood Pressure and living longer - Everything you ever wanted to know
No 51 - Statins - all you need to know
No 52 - The History and Summary of Anti-Depressants
No 60 - "How Doctors Think", a book review
No 36 and 37 were ideas, that I got a bit fixated on. Why isn’t there a simple, short, easy history of the common treatments we use in primary care?
I started writing some of my own simple posts (above) and then thought about submitting a post to SAPC (No 77 above). I thought that it would be quick and easy to find 10 papers that would be “core knowledge” that all primary care clinicians should know about. I also thought it would be simple to find these papers and pretty obvious what they were.
I thought the history of EBM would be simple to summarise onto a poster. And then, this poster and its simple list would be easy to turn in short introductory lectures that could be given to medical students and GP trainees. How wrong I was!
The good news, is that the poster abstract was accepted. The bad news, was I then had 2 months to finish doing the work. I wasn’t really expecting it to be accepted and I had horribly underestimated the reading that I would need to do.
Helen and I then spent weeks reading through hundreds of articles and websites trying to find anything relevant to primary care medicine and EBM. We then ran the list past some colleagues and asked for feedback and additional important landmark developments.
Originally, I had thought this would be mostly about drug development and RCTs but as time went on I didn’t find many. What we did find was lots and lots of policy, guidance, social change, organisational change, consultation change, technological change and adaption of medications from specialities to primary care.
In this post, I just want to set the scene and show how we got from a blank piece of paper to the poster presented at SAPC and in No 77. In future posts, I may come back to certain areas in more detail.
I would also like to ask anyone who reads this, to please suggest any topics or developments that we may have missed? I have already received quite a few helpful suggestions that I plan to add at another time.
The Timeline and Poster Making Process
220 lines on an Excel spreadsheet, 90 references, hours of work.
We then turned in into this massive table, that didn’t fit on the poster:
Finally, Helen was able to cut a significant chunk out of the table and we had a work-able poster. We were also able to cut down the 90 references we used to make the draft timeline and decided that these 24 were a good place to start for any students interested in the history of primary care, medicine, EBM or drug development:
Top Recommended References:
1.McConville K. The history of GP training. InnovAiT. 2023 Mar 1;16(3):115–9.
2.Hellenberg DA. A short history of academic general practice in UK medical schools. Afr J Prim Health Care Amp Fam Med [Internet]. 2013 Jan 1 [cited 2024 Mar 8];5(1). Available from: https://tinyurl.com/35ftb56x
3.Mughal F, Atherton H, Reeve J, Mallen CD. Academic primary care: challenges and opportunities. Br J Gen Pract. 2022 Feb 25;72(716):104–5.
4.Howie JG. Academic general practice: reflections on a 60-year journey. Br J Gen Pract. 2010 Aug 1;60(577):620–3.
5.Kmietowicz Z. A century of general practice. BMJ. 2006 Jan 7;332(7532):39–40.
6.Loudon SL. The origin of the general practitioner. J R Coll Gen Pract. 1983;
7.Horder JP, Swift G. The history of vocational training for general practice. J R Coll Gen Pract. 1979 Jan;29(198):24–32.
8.Nuffield Trust [Internet]. [cited 2024 Mar 8]. The history of the NHS. Available from: https://www.nuffieldtrust.org.uk/health-and-social-care-explained/the-history-of-the-nhs
9.Porter R. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present. Fontana Press; 1999. 833 p.
10.SAPC-admin. SAPC. 2015 [cited 2024 Mar 8]. A short history of SAPC. Available from: https://sapc.ac.uk/article/short-history-of-sapc
11.Bynum W. The History of Medicine: A Very Short Introduction. OUP Oxford; 2008. 185 p.
12. Gray DP. History of the Royal College of General Practitioners--the first 40 years. Br J Gen Pract. 1992 Jan;42(354):29–35.
13. Simon C. From Generalism to Specialty—A Short History of General Practice. InnovAiT. 2009 Jan 1;2(1):2–9.
14. Balint M. The doctor, his patient, and the illness. Lancet. 1955 Apr 2;268(6866):683–8.
15. Collings J. GENERAL PRACTICE IN ENGLAND TODAY -A RECONNAISSANCE. The Lancet. 1950 Mar 25;255(6604):555.
16. Keys A, Anderson JT, Fidanza F, Keys MH, Swahn B. Effects of diet on blood lipids in man, particularly cholesterol and lipoproteins. Clin Chem. 1955 Feb;1(1):34–52.
17. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. Factors of risk in the development of coronary heart disease--six year follow-up experience. The Framingham Study. Ann Intern Med. 1961 Jul;55:33–50.
18. The World Medical Association Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Subjects [Internet]. 1964 [cited 2024 Mar 11]. Available from: https://www.wma.net
19. Hart JT. THE INVERSE CARE LAW. The Lancet. 1971 Feb 27;297(7696):405–12.
20. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637–41.
21. Sabatowski R, Schafer D, Kasper S, Brunsch H, Radbruch L. Pain Treatment: A Historical Overview. CPD. 2004 Mar 1;10(7):701–16.
22. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007 Jul 21;335(7611):136.
23. Stein SW, Thiel CG. The History of Therapeutic Aerosols: A Chronological Review. J Aerosol Med Pulm Drug Deliv. 2017 Feb 1;30(1):20–41.
24. A short history of general practice: Consumerist medicine – BJGP Life [Internet]. 2022 [cited 2024 Mar 11]. Available from: https://bjgplife.com
Full references (all 90) can be found here:
