Ten years ago I sat through a 2 year Masters programme in Health Services Research at the University of Sheffield.

I enrolled because I wanted the answer to one question, "How can I conduct meaningful practice-based research?"

First and foremost I am a clinician. I love seeing patients and I love the fact that I can make a difference to their lives. At least that is what they tell me.

And the truth is that I get rather peeved (to put it lightly) when people who want to feel important jibe me or my profession with "Where's your evidence?" or "How do you know you made a difference?"

Hence my quest to the University of Sheffield where I studied with real experts in healthcare research.

Well, after a lot of sweat, tears, study and questions, I finally found my answer. It's not possible.

The accepted scientific process does not fit with practice-based research.

Well that left me thoroughly disillusioned with research and the research process. But now it seems, there is an answer.

Let me explain .....

The scientific method aims to remove the enemies of research - chance, bias and confounding. This is done by a process of control. Healthcare experiments are either placebo-controlled (impractical except in drug trials) or randomised controlled where random allocation of subjects to the control or experimental groups will reduce the risk that a researcher places those more likely to get better in one group or the other.

This is a huge barrier to practice-based research.

Our patients are paying for treatment, not to be experimented on. If someone is paying for my service, I couldn't ethically deny that person my best treatment, even temporarily, in the interests of research.

To do a randomised controlled trial I would have to treat the treatment group for free and attract patients willing to take part in the experiment (sometimes even paying them to take part), devoting enormous time and resources to the process.

While I might be able to prove to that a certain one of my treatments is beneficial to certain patients, that result would not be applicable to other practitioners.

So I would have to convince others to participate in the trial.

The structure of the RCT is such that only subgroups are tested. An RCT tests one or two aspects of treatment, on a minority of patients, using a minority of clinicians. Bias and chance are almost guaranteed; yet this is supposedly our gold standard? These microscopic snapshots form guidelines that everyone is supposed to follow? It is ridiculous.

Then it dawned on me. What if we take chance and bias out of the equation all together. What if we just measure our results and then compare our results with ourselves and then with anyone else?

Outcomes assessment is an important and well-respected part of research. The most commonly-used tools have been validated and checked, but there is little consistency in use, so it becomes impossible to generalise the results.

What we needed was a validated, easy-to-use, online, patient-centered outcomes assessment delivered automatically to the majority of our patients with medium to long-term followup.

This is exactly what Record Your Results was set up to achieve. I have been testing and refining the system over the last 6 months and it is now ready to go.

I use it to manage my patients and my practice better. At a glance I can pick out any patients who aren't improving or getting worse.

I can get snap-shots of my practice and see what type of patients I am seeing and how quickly they get better.

I can even enter data to record to find my cost-effectiveness and follow this over time so that if I modify my approach, I can measure the effects of those changes.

It takes about 15 seconds to enter the patient's details onto the system and the rest happens automatically.

Patients are then sent new questionnaires at baseline, 7 days, 14 days, 28 days, 2 months, 3 months, 6 months and 12 months after treatment.

At any stage I can sit down with my patients and find out how they perceive their progress and what is stopping them feeling 100%. I can also get them to see how my treatment is changing their condition and their health in the long term, not just with the pain they have today.

In time, as the body of data grows, I will have real data on which to base any advertising and claims I wish to make and I will be able to counter the non-believers who say "where is your evidence" with the counter of "where is yours?"

Simon King