General practice, a patient-centered discipline, a physician-centered research : a paradox ? About doctoral theses

Context: General practice and its teaching claim a patient-centered approach. However, general practice research tends to study the general practitioners themselves rather than their patients. What about general practice theses ? Objectives: The objectives of this work were to describe the subjects of general practice theses, to identify the determinants influencing the choice of subject, and to explore the reasons for these choices. Method: This descriptive and analytical study identified the characteristics of general practice theses submitted to the Faculty of Medicine of Marseille between 2009 and 2015. Multivariate regression was used to assess the association between various characteristics and the fact that the thesis did not include the patient in the object of study. Results: Of the 743 theses analysed, 47,8 % did not include the patient as their subject of study. In multivariate analysis, the probability of not integrating the patient increased when the subject was in the field of general practice (OR = 1,93 ; 95CI = 1,29-2,87) or when the director was a general practitioner (OR = 1,56 ; 95CI = 1,11-2,21) after adjustment. However, over the observed period (2011-2015), the proportion of theses that didn't include the patient as the study subject did decrease. Conclusion: Several hypotheses may explain this tendency of general practice residents to focus more on general practitioners rather than their patients, including: their fears about their own future clinical practice, and their search for professional identity; their willingness to study the doctor-patient relationship; difficulties in recruiting patients due to ethical requirements and recent legislative changes. These hypotheses might help guide the future supervision of theses to encourage more general practice residents to focus their research on patients.