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LETTERS: Kerr L White Campaign to revitalise academic medicine: Some thoughts for academic revisionists to consider BMJ 2004; 328: 1378 [Full text]

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Not this degree of revision...

David Barnes   (10 June 2004)

Not this degree of revision... 10 June 2004
David Barnes, Semi-retired General Practitioner Home SG12 8RE Send response to journal: Re: Not this degree of revision...	Kerr L White lists in his letter just the views which are going to hold up progress. It is the likes of Koch, Pasteur, Laveran, Castle, Lind, Dale, Landsteiner, and Lister etc., who started the routes which have brought us to where we are. In effect, they discovered the causes of effects. So, normally today most infections and vitamin diseases are within the scope of curative treatment, but not one major neurological illness is understood. And not much else in the broad perspective of the practice of medicine either. The quality of research today is nauseatingly poor. This is a difficult thing to accept but we should not give up now. Unless the very best pure research admits it has come to the end of the line, and if it has it ought to, there really is no fundamental need for the social-worker based soft approaches, founded for example on the described trendy comprehension of unexplained clusters, sequences of elements required to evoke changes, and somehow depression. Further, we are to become biomedical worldview social workers, we are to expand patients’ homes and hospices as major educational venues, we are to replace the emphasis on causes with ‘profiles’, we are to be knowledgeable in concepts and limitations in perspectives in medicine (do we put in smaller fee invoices? or none at all?), we are to shrink basic science courses in favour of long exposures to rationales, of aspects of interventions, of worry about costs and near aircraft misses; we are to undertake essay courses on medical encounters, the history of medicine and even, praise be, the scientific method, and we are each to write two papers on the labelling of illnesses, their criteria and prevalence etc. Why should any of this explain the final common pathway in any pathology? One fears this is how one needs to read this letter in terms of its universal failed philosophy of health jargon. It’s the wrong route. Bedside manner approaches are not enough. Chats among all manner of awareness people, historians and people who are very understanding, are not good enough. Give us a cure any day. If it’s too hot in the kitchen one shouldn’t be in it and one should say so. As one studies his list for the future development of medicine we are in very eminent danger of becoming soft and flabby, but wealthy maybe due to time to be spent by everybody on consequential patient contact. David Barnes. Competing interests: None declared