Tom Spears
The Ottawa Citizen

March 16, 2004

Dr. Jeremy Grimshaw's work summarizing medical reports is a boon for doctors too busy to keep up on discoveries themselves.

Out of all the medical awards you might imagine -- ace pediatrician, top-gun family doctor -- a unique prize will go today to an Ottawa doctor who organizes global "Coles Notes" for harried doctors with no time to stay on top of every discovery.

Dr. Jeremy Grimshaw of the Ottawa Hospital Research Institute won't get any money -- only the glory. And since the prize itself is nearly unknown (quick, can you say Knowledge Translation Researcher of the Year?) it's a little like winning gold in a brand-new Olympic event.

Dr. Grimshaw has no patients. But what he does may influence how your doctor treats you.

Today, the Canadian Institutes of Health Research will honour him for carving out a new medical field -- the task of boiling down the vast flow of information on new medical discoveries so that a busy clinical doctor actually has time to absorb it.

There's medical news every day. Yet the nature of a doctor's life is an obstacle to learning about them.

Long day. Busy schedule. No let-up.

As well, many physicians are paid according to the number of patients they see. Taking time away from patients to study and become better doctors actually costs them money.

"Someone calculated it would take close to 40 hours a week to keep up, just reading the general medical journals," says Dr. Peter Tugwell of the University of Ottawa's Institute of Population Health.

Then there are specialty journals -- on cancer, heart disease, and so on. "So what we increasingly need is a way of pulling that information together, so that new information is added to existing information" to summarize an overall topic.

It matters, he says, even in the simplest matters -- "the treatment of sore throats, the treatment of how important immunization is -- how to handle the controversy over ... the false correlation with autism that's out there.

"To have the information at their fingertips, I believe, is incredibly important. So they need a website or some sort of paper version ... that actually provides them with something that is synthesized, but is of a high quality. And that's what Jeremy is all about.

Trained as a family physician in Britain, Dr. Grimshaw came to Canada two years ago and holds a Canada Research Chair in Health Knowledge Transfer and Uptake. He is director of clinical epidemiology at the Ottawa Hospital Research Institute and director of the Centre of Best Practices at the Institute of Population Health.

He's one of two Ottawa doctors to receive a CIHR award today: Dr. Henry Friesen of Genome Canada, who headed the former Medical Research Council for 10 years, will received an award for leadership.

For 15 years Dr. Grimshaw has been studying how to support doctors in their efforts to use new medical knowledge to help their patients.

"One of the most consistent findings we have ... is that there's a gap between what the evidence says we should do, and what health care systems and health care professionals manage to deliver," he said.

For instance, 30 to 40 per cent of patients in a variety of developed countries, including Canada, aren't getting the most effective care, and 15 to 20 per cent get care "that is either unneeded or harmful."

One example: Many doctors order X-rays of the lower spine and back for people who suffer from lower back pain. This isn't much help in diagnosing the problem, Dr. Grimshaw says, and it exposes the patient to a substantial dose of radiation.

There are two barriers to doctors who want to keep up with the latest research.

"The first is the sheer volume of the research that's out there," he says -- some 20,000 editions of various medical journals around the world each year, once one counts all the specialized niche publications. But how can any doctor -- who may have a scant hour per week to read the medical literature -- sort the essential from the junk mail?

"We've made quite a lot of progress in the last decade in ways to improve that information overload," he said. One is the collaboration by 7,000 medically-trained volunteers around the world who sift through the mass of research and boil it down to the points that matter most.

This group, called the Cochrane Collaboration, is a non-profit organization that publishes its synthesized version in a library open to all. Dr. Grimshaw is co-ordinating editor of a major Cochrane group.

The second obstacle is the "frantic and chaotic" nature of the health care business, he said.

A doctor who has to deal with multiple crises quickly isn't in a position to sit down and mull the options. "The human brain doesn't have the information-processing capacity to handle all the calls on it," he said.

"Science is going so fast today that the gap between what we know and what we apply is actually getting larger," says Dr. Alan Bernstein, president of the CIHR, which funds medical research in Canada.

"It comes down to: We're all busy; we're used to doing things the way we're used to doing them; we're also in a period of profound change ... and humans have a natural resistance to change."

Dr. Tugwell calls the research synthesis a "friendly front end" -- a single package tailored to busy doctors, with the credibility of major medical organizations such as the Royal College of Physicians and Surgeons of Canada.

The easy road for Dr. Grimshaw would have been to stay in family medicine and do traditional medical research. But Dr. Tugwell, who nominated him for today's award, says he took the risky path of trying to persuade people that learning how to tell doctors what they need to know is a legitimate medical field on its own.

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