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Rapid Responses: Rapid Responses published:
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Do doctors need to be scientists?
- Abdul M Khan (18 June 2004)
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Neither scientists nor nutritionists - perhaps artists?
- Dr. Herbert H. Nehrlich (18 June 2004)
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Scientists mind
- Lúdvík Ólafsson (18 June 2004)
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A noteworthy omission
- Steven Ford (19 June 2004)
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Medicine is an art as well as a science
- Philip A Branton (19 June 2004)
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Generalisations and more generalisations
- Raymond L. Friedman (19 June 2004)
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Medical Students - Physician-scientists of Tomorrow
- Fawad Aslam (19 June 2004)
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Doctors as Scientists
- Dr Ram K Dikshit (19 June 2004)
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Jazz Musicians have to study too!
- Richard D Kennedy (19 June 2004)
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Doctors are true scientists
- B M Shrestha (19 June 2004)
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Are doctors not scientists ?
- Paras K Pokharel (19 June 2004)
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"Science is a way of thinking...
- Carlos Cuello (20 June 2004)
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Science is Lacking in the U.S.
- Steven M. Kilpatrick (20 June 2004)
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DOCTORS ARE TRAINED TO ACT IN BENEFIT OF PATIENTS
- CELIO LEVYMAN,MD,MSc (20 June 2004)
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Medicine and Magic: Science and Sorcery.
- Cynthia M Lewis (20 June 2004)
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Some doctors are not scientists, others are semi-scientists but all are scholars: Pride and prejudice.
- Diaa Essam El-Din Rizk, None (20 June 2004)
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Lack of maths in medicine
- Angel Luis Martinez (20 June 2004)
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Doctors Vs Scientists
- S Gada (21 June 2004)
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Doctors should have scientific mind NOT only BELIEF in science
- Pisut Katavetin (21 June 2004)
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Doctors and Science
- Catherine Gilbert (22 June 2004)
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Who am I? A personal note!
- Zubair Kabir (22 June 2004)
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Suck it and see
- Tom Hughes-Davies (22 June 2004)
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Doctors need to be critical thinkers
- Naeem A Jafarey, Karachi. Pakistan (22 June 2004)
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A doctor is one who gives the right answers
- Akheel A Syed (23 June 2004)
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If only !!
- Pat Davis (23 June 2004)
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Doctors are not Scientists, Scientists are not Doctors
- Masum Hossain (23 June 2004)
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Good lord deliver us
- Shyam S Kothari, Newdelhi,110029 (23 June 2004)
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From bench to bedside, and back again
- Mr Malcolm A Buchanan, Mr Paul IA McMurtrie, MB/PhD student, University of Cambridge (23 June 2004)
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But doctors need a scientific outlook
- Arun S Nanivadekar (24 June 2004)
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Emergencies Only, Please
- Jane M LORD (24 June 2004)
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Nonscientist doctors fall prey to medical fraud camoflaged with science
- Andrew H. Cutler, Sammamish WA 98075 USA (24 June 2004)
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Do patients fall prey to medical fraud camouflaged with science?
- Brian Morgan (25 June 2004)
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The clinical method is the scientific method applied to the care of a patient
- Alfredo D. Espinosa-Brito, José M. Barmúdez-López (27 June 2004)
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Everyone a scientist, rarely
- Robert A. Da Prato (28 June 2004)
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But we still need science
- David L J Freed (29 June 2004)
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Clinicians as inadvertent scientists?
- Eric J Will (30 June 2004)
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Doctors do know science
- Marwan M Azar (9 August 2005)
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Abdul M Khan, Medical Student The Aga Khan University Karachi 74800
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Well if we look at the general trend the notion that doctors are not scientists seems to hold true. Most of the doctors will go about reading articles with no idea of where to start and where to end. But at the same time restriciting the definition of a scientist through the examples quoted in the above piece of writing doesn't do justice. For me a scientist is anyone who seeks. And thus any doctor who wants to practice evidence based medicine has to read and then interpret the papers published in his or her local journals. To me this makes him a scientist as he questions and then finds answers. Whether or not reading papers generates an interest in him to go on and do some research work himself is dependent on many other factors. A doctor in a third world country, for example, maybe restricted from doing this due to financial constraints. Similarly another doctor may not have time to go on and engage in a research work that requires both efforts and time. Competing interests: None declared |
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Dr. Herbert H. Nehrlich, Private Practice Bribie Island, Australia 4507
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If Doctor Smith were to ask a room full of doctors for a show of hands of those who are experts in nutrition he would possibly experience a similar reaction. Yet this doesn't stop your average GP from handing out advice to patients on eating habits, types of foods to avoid, and how to feed your baby. Since nutrition is a very substantial player when it comes to determine human health and avoidance of disease you would think that medical training would put some emphasis on it. But this has still not occurred. Perhaps that explains why doctors still preach the mindless and damaging advice on cholesterol, saturated fats and food supplement avoidance. It has become routine that representatives of the pharmaceutical companies help to educate doctors on things concerning foods and nutrition; there is ample time during their 19 visits per month. Of course, these men with the big sample cases rarely know more than their spoiled pupils so the lessons soon drift back toward the real thing, the drugs. Perhaps, as our editor Dr. Richard Smith describes how a bee will actually suck some honey from a flower(!?) these doctors, too are a bit short on science and long on confidence. Competing interests: None declared |
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Lúdvík Ólafsson, Chief Medical Director Heilsugaeslan, Barónsstíg 47, 105 Reykjavík, Iceland
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Some doctors are scientists - some are not. What makes the difference is not what they do, rather how they think. It impedes the discussion to confine the definition of scientists to person who work in research. A scientist is a person who thinks as a scientist when solving problems. In his daily work every doctor accumulates information (data), the way he uses this information determines whether he is a scientist or not. Being able to draw "logical" inferences from data is what matters. Competing interests: None declared |
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Steven Ford, GP Haydon & Allen Valleys Medical Practice. NE47 6HJ
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Editor Controversial to the last! But was the greater controversy the published copy or the omission from this week's edition of any mention of the, surely noteworthy, submission by Chris Hawks to the recent AMA meeting. Whilst only firebrands and unrepentant controversialists might decline to offer treatment to plaintiff's lawyers (specialising in medical negligence) and their spouses, to have ducked this opportunity for debate is a cause for regret. The BMA might consider auditing the behaviour and results of medical negligence lawyers in order to identify those that may be exploiting patients and the system for their own economic advantage. Arguably, such behaviour is a species of negligence itself, it is certainly antisocial. Meritorious actions must be brought to the courts but a mechanism is required to sharpen the lawyer's differentiation between them and the mass of other actions that are likely to fail. Making the plaintiff's lawyer liable for the defence expenses when a case fails or never reaches court would go a long way to achieving a higher percentage of meritorious cases reaching a full hearing and usefully limit indemnity costs. Steven Ford Competing interests: Very sympathetic to the plight of Chris Hawks - a plight to which we are all vulnerable. |
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Philip A Branton, Vice Chair, Dept of Pathology Fairfax Hospital, Falls Church VA ,USA
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Dr Smith's observation's are right on target, but I must also point out that medicine is at least 50% 'art'. We all know of colleagues who have a peculiar knack for certain diagnostic abilities. I have known several surgical pathologists (my specialty) with an incredible synesthetic visual database, able to extract miraculously unusual (and ultimately correct) diagnoses. I would argue that these and other diagnostic wizards are more artists than scientists. And this should be celebrated! The 'scientific training' that doctors receive mainly trains them to assimilate large masses of data, sift it, and extract what they need to care for their patients in their chosen specialty. And that is a rare and wonderful gift, one might say, an art. Competing interests: None declared |
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Raymond L. Friedman, Private Otorhinolaryngologist Johannesburg,South Africa 2052
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We are continually bombarded by such generalisations in our professions, especially in BMJ type publications, See ( "Doctors are not scientists" and some responses). Surely to put it briefly, if a doctor has a tiny area of special interest, and studies all articles in such field intensely and with a questioning mind, he satisfies the definition. Its a rediculous question. The major thrust of all these articles written by "scientists" is to stimulate. Stimulate interest, learning and questioning at whatever level. If one had to ask the same audience of 150 doctors the question as to who had in any way learned something, changed a direction, been spurred to greater heights or actually just sat in awe and amazement after reading an article - the response would be significant. Whether its in areas of medical management, cost containment, learning, ethics or whatever we are being judged by few (saints), on the actions of a few with the appropriate applause of few. One day it would be appropriate to see judgement on all those who have proposed all the amendments seen in medicine, cost management and ethics that have cost fortunes to implement and gone nowhere. Somehow, these judgement calls are not subject to the same scrutiny as those of us lesser mortals. Competing interests: None declared |
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Fawad Aslam, MBBS student The Aga Khan University Medical College, Karachi, 74800, Pakistan.
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EDITOR – It is very true that most doctors are incapable of critically appraising scientific articles. Doctors, at least quite a few of them, must not only be capable of critically analyzing research but they should also be capable of producing critically designed research. We need to produce physician-scientists. Physician-scientists may be described as doctors who devote a majority of their time in seeking new knowledge about health and diseases through research. As their numbers decline (1), efforts must be made to address this issue at the elementary level. One option is to target medical students. Medical students should be mentored to conduct and publish research. If they are consistently engaged, there is a good probability that many will go on to pursue the exciting and essential field of research. This will be very helpful for the developing world which stands deprived of health research and health researchers. A lot of impediments in the shape of low research awareness, inadequate funding, lack of mentors and poor infrastructure must be removed before progress can be made. A strategy must be formulated to target the physicians of tomorrow. Once a critical mass of physician-scientists is established, snow-balling will start and hopefully, more hands will be raised for Mr. Smith. REFERENCES (1) Rosenberg L. Physician-scientists-endangered and essential. Science 1999;283:331-2. Competing interests: None declared |
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Dr Ram K Dikshit, Professor of Pharmacology B J Medical College, Ahmedabad 380 016, India
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No, certainly they are not. Nor they are trained to be so (which they should be). Consequently most doctors can just be called as medical literates (and not medically educated). But I think the bigger questions is do (or should) they bother about it ? Competing interests: None declared |
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Richard D Kennedy, Clinical research Fellow Cancer Research Department, Queen's University, Belfast, BT9 7AB
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I agree that most doctors are not scientists, nor are they teachers, councillors, accountants, craftsmen, lawyers etc. The point is that medicine is a unique occupation that encompasses a number of skills. I believe the ability to assess original research is one of these skills. The notion that you have to be a scientist to read a scientific article is seriously flawed. To use Dr Smith’s own analogy, doctors may be like Jazz musicians in their ability to improvise but as any musician will tell you, improvisation only follows long hours of mastering the theory of music. Similarly, doctors need to be aware of the basic concepts underlying their practice before they are safe to improvise. The fact that "most doctors are incapable of critically appraising an article" reflects the failure of medical training in the past to inspire doctors to seek fresh knowledge. I believe the willingness to accept other peoples’ opinions on original scientific research is dangerous, as medical practice can then be influenced by factors such as drug marketing rather than what is best for the patient. Competing interests: None declared |
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B M Shrestha, Consultant Surgeon Northern general Hospital, Sheffield, S5 7AU
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I read with interest the editorial in the BMJ1 stating doctors are not scientists, which provoked some thought on this sensitive issue. Doctors do fulfil the definition of scientists and hence they are scientists in true sense. By definition, scientist is a person learned in science, especially natural science (physics, chemistry and biology) and is a scientific investigator utilising the methods or principles of science. The word science is derived from Latin scientia means having knowledge or a system of knowledge covering general truths as opposed to ignorance or misunderstanding. Basically, doctors are highly selected group of personnel who are well motivated, dedicated and hard-working and go through a rigorous training prior to undertaking the responsibility of making decisions on patients lives. Their practice is based on sound principles of medical science and particularly in the current climate of tight clinical governance, doctors work in a multidisciplinary team rather in isolation, thereby share each others experience and knowledge for the benefit of the patients. The work is audited at regular intervals and changes in practice are made based on their outcomes. Experience gained from mistakes is used to improve the performance. It is not absolutely necessary for the doctors to handle millions of data to be designated as scientists. Critical appraisal of literature and clinical or laboratory-based research has become a routine in the medical curriculum. Therefore, a doctor is a scientist in true sense as he applies his knowledge and experience based on scientific principles and contributes significantly towards ameliorating the sufferings of the patients and saves numerous precious human lives. This is particularly true in the current environment where doctors are struggling hard to meet the overwhelming demands in providing basic health care. 1. Richard Smith Doctors are not scientists, BMJ 2004;328 (19 June), Competing interests: None declared |
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Paras K Pokharel, Associate Professor BP Koirala Institute of Health Sciences,Dharan,Nepal
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Dear Richard Smith Every human can be genius to be scientists as it goes the meaning in Oxford English Dictionary Scientist:A person who studies one or more of the NATURAL SCIENCES (for example Physics,chemestry and biology).A research scientist,nuclear scientists.The cartoon of person working in laboaratory. Computer Scientist,Political Scientist,Social Scientist. We feel editor is concern about health or medical scientist in this case.Core issue lies do we inculcate in medical education carricula in formative years the Inquisitive Approach .To our part of world, Medical eduaction is dominated by memorizing the facts ,including those which one is never going to be used.Examiner is intrested to evaluate short term memory rather than iclination toward so called medical sciences. There are huge scarcity of teachers to teach basic sciences in Medcal School all over the world.Bed side teaching or running with busy consultant alone will not produce scientists from Doctors community. Problem Based learning advocated last few years has some hope in critical thinking in new generation doctors and wish they will meet the expectation of Editor . If you see numbers of the doctors produced in developing nation and minimum contribution to solve their own health problems makes them isolated in planning commisison of country .Other allocate ,dictate & manage health realted events,doctor are not in seen in such important affairs. So editorial has created a resonance to interocept ourselves. Do we all doctors can take part all round affairs including sciences in Health? Competing interests: None declared |
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Carlos Cuello, Professor of Paediatrics. Tecnologico de Monterrey, School of Medicine Av. Morones Prieto 3000 pte 64710 Monterrey, Mexico
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...much more than it is a body of knowledge..." This is quoted from a great scientist that I took as a role model, Dr. Carl Sagan. When I was a child I wanted to be a scientist, but I also wanted to help people, and perform some kind of art. Medicine is perhaps one of the few areas of science that combines human contact, art and scientific knowledge. From my point of view, some doctors tend to perform more on one of these aspects... I recommend my students to stay in an equilibrium between the art and the science. A scientist is a child, curious, imaginative, who keeps wondering and skeptic when faced with a new theory, enjoys not only in finding new evidence, but (as Sir William Bragg said) in discovering new ways of thinking about it. As a patient, I would love to be attendend by a scientist, with a human touch; the lacking of any of these, is lame. Competing interests: None declared |
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Steven M. Kilpatrick, President - Medical Software Company KEC 2612 Manor Way Dallas, Tx. USA 75235
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Physicans must work in the U.S. in an enviornment that stifles creative science, even if the practioner were inclined to embrace it. Nutrition as it relates to overall health, as referenced by Dr. Nehrlich, is a perfect example. Our current research and reporting methodology, per peer review, double blind studies, seem to restrict the common sense medicine of the past, that may be highly applicable today. Biomedical progress with autistic children is a valid example of advancing treatment protocols, that remain lost in the treatment options that Pediatricians might discuss with the parents of an ASD child. Do they gain knowledge of these and other vaild options via the journals? Often times they do not. Competing interests: None declared |
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CELIO LEVYMAN,MD,MSc, Senior Neurologist Headache and Neurology Clinic,Rua Jose Janarelli,199,cj. 22,Sao Paulo,Brazil,CEP 0156-010
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Doctors are trained to act in direction of patients good health.However, Medicine is such a profession that make possible a wide range of opportunities to work: as an a GP,a specialist, a researcher, an epidemiologist and even as a politician…Generally speaking, doctors are not scientists. When Abraham Flexner published his famous report in 1910, a lot of things changed in North America. Curious one Flexner: acting for some years as a principal of high schools in USA, turned to have a degree in Education at Harvard University and then travel to Europe, and he was widely impressed by the German methods, in special at the University of Berlin. Returning to States, he was turned as a member of a Comission of Education of the Federal Government, and make the research about medical schools that was the basis of his report: he wasn’t a doctor, but detected that something like 2/3 of medical schools at this time in USA and Canada are only money-making ones, profit institutions that given worse education. His pointed and ranked the medical schools in North America and have proposed the Flexner method, an adaptation of Berlin education of doctors: two years of basic disciplines, like Anatomy, Physiology, Biochimestry, etc.; two years of Clinical and Surgical Disciplines and two years of hospital practice, as an Intern. With few modifications, this model is widely the floor of the curriculum of many medical schools around the world. Despite the modifications, what can we consider the primary objective of medical schools after the Flexner reform? Give an MD to a graduate on to practice good Medicine, to care people. Some years later was introduced the Residence apprimoration after the graduation, as the Osler style, an immersion in the medical real life. And residence and fellowship programs were and are still now the entrance door to practice a medical specialty. Of course research was performed, but the primary goal of a medical school is to prepare good doctors. If one desire to make research, they will be properly trained. More recently, in the 80’s, Mc Gill University introduce the PBL: an epidemiological research determines the problems of a given population where the medical school is located, and the Problem Based Learning programs was directed to them. But also this kind of system make a revolution in the classical Department schools, with the Tutor Professor, the Abilities Professor, the training with actor-patients, the contact with real ones in the beginning of the course, etc.I believe that at the present more than 100 medical schools adopt the PBL system, and the goal is also to graduate MDs to care people. If the young MD from a PBL school wants to be a cardiologist, he must to join a residence program, and also as he wants to be a researcher: this kind of education is turned to create good doctors, not scientists. But, in the middle of this we can observe a mixed of real pre- scientists, and the “market” demand of publication. The papers published act like money to turn a simple MD in a research-physician star! The things are confusing one with another. Here in Brazil, an in Israel at the Technion as I know, there are post-graduation courses not in basic sciences only, but in clinical and surgical ones. After the residence, a doctor could ingress in such programs to obtain a Master in Medical Sciences degree and/or a Ph.D. in Medical Sciences. I have such a degree of that: I am Master in Neurology.Well,I have more classes and courses, more practice training, a basic formation in Pedagogy and Statistics and I receive my diploma after the conclusion and presentation of a Thesis, analyzed by a five-member examination team. And believe me; these things do not turn me in a better physician, or in a scientist or even in a good professor. In my country are post-doctorate fellowships, but also an antique modality of graduation: the Privat Dozent,based in some European pre-WWII Universityes.After the Ph.D. and with a lot of papers published,the physician could be analyzed in a week maratone:memorial and curricular analyzes,a difficult dissertation test,a practical test (as a surgery,for instance), an oral test,an examination of an magisterial class and the presentation of a Thesis (the third in a career) to a five member privat- dozent professors.And if he wants the post of Professor and Chairman, a new examination of the curricular life of the candidate and a masterpiece class !After all this complex procedures, the Chairman is an illuminate human being, a scientist-physician highly refined ?Of course not. Some of them have brilliant minds and really deserve the position, but there are here a lot of very good physicians acting in primary care, with Master and Ph.D. degrees…Here we look to a manner to progression in academic positions, but not necessarily the chosen will be a good scientist or even physician… And an interesting thing is occurring in USA,probably created after the observation that the MD result of the regular schools is not a scientist by itself: programs like the MD/PhD ones such Harvard Medical School/Massachussets Institute of Technology and University of Pittsburgh School of Medicine/Carnegie Mellon University speaks for there ones. A scientist must have proper skills and laboratory training, for example. Almost here, in South America, the real scientists who have and MD have turning the carreer into and Institute of Research at the Universities, acting no more as physicians. And the necessary clinical and/or surgical research of quality is performed by MDs, formerly MDs who turned itselfs into science only and other professionals, like biomedical, bioengineering, biology, mathematics, etc. fellows, in a multi- disciplinary way. Only publish papers or have titles as MMSc or PhD does not transform a doctor in a scientist. In short words: doctors aren’t scientists, but they can be, observing the rigid and ethical procedures to make real contribution to Medical Science, and not only collections of papers and papers. Competing interests: None declared |
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Cynthia M Lewis, retired DE4 5HS
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The editor tells us that a scientist generates “falsifiable hypotheses” – a choice of phrase appropriate for a wordsmith. Would the words “verifiable hypotheses” have had a different connotation? A scientific approach is to be applauded, and many doctors are scientists by inclination, viz Hunter’s self-injection of puss from a syphilitic sore. And the editor should not treat learning from personal involvement with such disdain – “experience is the best teacher.” Whether a doctor is, or is not, a scientist is unimportant. By analogy, a pilot doesn’t have to be an engineer in order to fly a plane – a pilot only needs basic understanding of the sciences that allow him to practise his art: meteorology, aerodynamics etc. Where medicine differs is that much of the science is lacking – only about 20% of medicine has an evidence base. And even those who think, “medicine is an art”, must agree that more and better quality science is needed: without it we would still be letting blood, or removing teeth to treat anaemia. By analogy, medicine is at present a bit like a pilot trying to fly a magic carpet: full of uncertainty. Any principle that might modify its course, whether “uncertain” or not would be welcome. Competing interests: None declared |
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Diaa Essam El-Din Rizk, Associate Professor of Obstetrics and Gynaecology Faculty of Medicine and Health Sciences, UAE University, PO Box 17666, Al-Ain, United Arab Emirates, None
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I read with interest the editorial of Richard Smith. The three pillars of any profession, including science, are knowledge, skills and attitude. The doctor is taught only core scientific knowledge in medical school but is not trained to acquire the skills of a professional scientist. This is very obvious when the scientific expertise and skills of biological scientists with or without medical qualifications (eg. biochemists, pharmacologists, physiologists, anatomists, geneticists….etc.) and clinicians are compared. For example, the general physician has a working knowledge of genetics, cytogenetics and human genome but can not perform karyotyping, fluroscent in-situ hybridization or polymerase chain reaction. Therefore, clinicians should not feel prejudiced by this article because he/she is not expected to be a scientist nor to read original research in this field. Most clinicians studying for higher academic degrees, however, have spent a period of apprenticeship training in a research laboratory. These individuals will have more scientific expertise and skills if they were able to maintain collaboration with the index science departments. Therefore, academic clinicians should consider this commentary with great pride since they can be categorized as “semi-scientists” because of their previous work experience and greater awareness of the scientific literature. Scholarly attitude- intellectual inquiry, hypothesis testing, deductive reasononing, logical assumptions, critical appraisal and continued education- is, I believe, the hallmark of being a scientist. This is not taught in medical or science schools at under- or post- graduate levels but is learned and nurtured during school education as a life-long proces. Hence, various medical schools are now realizing the importance of assessment and development of students’ aptitude throughout the curriculum to ensure that their graduates will continue to adopt the scientific approach in their professional career. All physicians, whether dedicated or academic clinicians, should thus endeavour to demonstrate the truth in Hippocrates aphorism “There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance” by fostering the spirit and vigour of science in medical practice and patient care. Yours sincerely, Diaa E.E. Rizk, MSc, MRCOG, FRCS, MD, Associate Professor, Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al-Ain, United Arab Emirates. Tel: (971-3) 7672000 Fax: (971-3) 7672067 E-mail address: rizk.diaa@uaeu.ac.ae Competing interests: None declared |
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Angel Luis Martinez, Specialist, Internal Medicine Hospital de Leon 24009 Leon (Spain)
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Any science, during its growing process, turns into a mathematical way. In medicine, we use knwoledge and tools that belongs to scientists, but we are not one of them properly. Most doctors, including me, have decided to sacrifice (worth or not, that is not the question) a solid scientific (mathematical, is the same thing) background looking for an inmediate benefit to the patient, based on a practical training and the development of technical skills. How many medical doctors could remember the three principles of thermodinamics or solve an differential ecuation? Sorry, but science deals with this kind of things. Sadly for me, most of clinicians (I belong to that group)are not able to manage such concepts. If in the future the career planning changes, and includes a better mathematical and statisctic aproach, may be the new doctors could be called scientists truly; now, we are still real and simple practicioneers. Competing interests: None declared |
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S Gada, GP Coventry
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Dear editor, This article did tickle my mind, to think what we are. It is true that most of us do not go through most of the articles in detail. Its also true that doctors are not scientists. Doctors can't be scientist, because we don't set out to discover / find out about something. We read through what has been found already by scientist and try to assimilate it. Present system don't allow us to be scientist easily. Because you are supposed to breathe and practice 'EBM', evidence based medicine. By the time we keep ourselve up-to-date with latest updates in the medical field of our interest, it will be like winning a battle, by this time we will not be in a position to declare war on one-self by trying to become a scientist. Finally, government / royal colleges / profession / GMC / new contract, expect and supports us to be followers of EBM, not to set out to find new things OR least to become a scientist.( who might question what they are for OR whats there significance OR what they are doing ? ) Competing interests: Wished to be scientist in past, but very doubtful presently |
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Pisut Katavetin, Internist Bangkok, Thailand
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Whether doctor are scientists or not need clear definition of 'scientist' and need more objective data. Doctors should be scientists or not? may be the more relevant question to ask. I think the answer would be 'YES' if we define a scienctist as the one who have scientific mind or scientific thinking process. Almost all of us belief in science no matter they think they are scientist or not. But we need scientific mind to do our best for our patients. Without scientific thinking process we are only BELIEF, with blindful confidence, in the 'MEDICINE religion'. Doctors without scientific mind may do the patients harm if they have a strong BELIEF in the wrong medical KNOWLEDGE. Competing interests: None declared |
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Catherine Gilbert, student ip33 2qz
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1. Define doctor (= definition 1) 2. Define scientist (= definition 2) 3. Does the possesion of qualities in definition 2 increase proportion of qualities defined in definition 1 in subject? Additional question: would the use of the scientific method be practical in a life-or-death situation? Competing interests: None declared |
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Zubair Kabir, Jobless India
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Dear Editor, The rapid responders till date seem to be a full-time clinician, a clinician-to-be, or a part-time scientist, and of course a few are general readers of the BMJ as well. There is no point going over all the controversies or the questions raised following this editorial. I guess readers as well as my fellow rapid responders might also be interested in sharing the perception of a clinician-turned-scientist with them. The reason I call myself a "scientist", because I am actively involved in conducting scientific research, following my MD. I not only left my clinical responsibilities the day I joined an MSc program, but also on my way to completing a PhD program. Just a background to set up a scenario! In other words, a 110% commitment is one of the main criteria. Could the period of research experience be one of the potential confounders? If yes, when should a young researcher get to be recognised as a senior scientist? Is it the same arduous journey of 14/15 years to be called a Cardiologist/Neurosurgeon? Could we strike a balance between the two, and take the pride of calling ourselves a clinician and a scientist simultaneously? It sounds to me not only the lack of commitment, but also the lack of a proper 'identity'! Here, I am, who is no more a clinician, but at the same time is not recognised as a scientist. A paradox indeed! One day, out of curiosity, I asked a common observation to one of my friends (an SpR in Respiratory Medicine) "Have you come across an increased proportion of lung adenocarcinoma among young female patients in the clinic over your six years clinical experience?" No convincing reply, suggesting the lack of ignorance (might be due to several factors), as well as the lack of interest/commitment to bridge the gap in his existing knowledge. On the contrary, he is financially more stable, popular among the lay-public, and the pharmaceutical companies take care of his international conferences! Nothing personal, but one of the several examples. In summary, one cannot have the cake, as well as eat the cake at the same time. Just a crude analogy. So, a sincere effort, with a genuine long -term commitment is warranted to get into the club of a relatively less- 'glamorous' ill-paid intelligent tribe! No short cut please. Competing interests: None declared |
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Tom Hughes-Davies, Retired paediatrician Breamore Marsh SP6 2EJ
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A doctor need no more be a scientist than a reviewer is an author or actor, but he too needs to develop by exposure. Every practice should subscribe to the New England Journal of Medicine, and every editor should follow it and Nature by inviting experts (not editors) to interpret the more difficult articles. Competing interests: None declared |
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Naeem A Jafarey, 1 Adviser 2. Chairman, Editorial Board 1. Ziauddin Medical University 2. JPMA, Karachi. Pakistan
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Dr Smith has initiated a lively discussion judging by the responses it has initiated. The consensus ( as I see it ) is though practicing physicians are not scientists in the true sense of the word, they need to be ‘critical thinkers’ ie able to critically evaluate the growing volume of new information for solving the clinical problems in hand. and secondly audit their own performance. From the educationalists point of view, the undergraduate programme should include some exposure to basic concepts of research methodology, biostatistics and epidemiology, and training in critical thinking. PBL is awaiting a long term appraisal whether it produces graduates with these skills. For Dr Smith and other Editors of journals like BMJ and JAMA the message is please more of review and best practice articles and no original research studies. Let the speciality journals take care of them. To alert the general reader to what is happening in the rest of the Biomedical field they should have a page of “Alerts” listing the ten most significant articles of the month published in a given month world wide. Competing interests: None declared |
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Akheel A Syed, Specialist Registrar & Clinical Research Associate University of Newcastle, Newcastle upon Tyne, NE2 4HH
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Car mechanics, who learn the theory of the constant volume Otto cycle of the internal combustion engine and who can diagnose and treat automobile failure, would hardly be described as scientists. And this despite their science being more real, more evidence-based. To paraphrase Claude Lévi-Strauss, the doctor is not a person who asks the right questions, he's one who gives the right answers. Although knowing the science is essential to giving the right answer, it is asking the question that makes one a scientist.
Competing interests: None declared |
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Pat Davis, Thyroid Group Helper home
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I have lost count of the number of times I have read or heard Thyroid patients say their doctors have said " Your blood tests are perfect " Why do I still not feel well ? says the patient " Medicine is not a precise science " is the constantly produced reply When oh when will Doctors recognise that what tests are correct on one persons metabolism are not correct for another What drug works for one patient does not work for another Doctors should keep an open mind and instead of being wedded to Blood tests etc actually open their eyes and remember all the signs and symptoms of Clinical Diagnosis that their forbears had to rely upon Then and only then will patients receive the care and concern and treatment they need to actually restore them to health instead of enduring an existance of non stop symptoms and ill health being told "its nothing to do with Thyroid or whatever ....its all in your mind " Competing interests: None declared |
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Masum Hossain, Medical Manager Australia
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True, doctors are not scientists, nor are they lawyers, accountants or social workers, but in their daily practice of medicine they must borrow a little from each. I have never heard the statement, doctors are not lawyers or doctors are not accountants or social workers, but then these professionals probably don't feel the need to justify their value or deal with such insecurities. Making a statement like this is as ridiculous as making a statement like "Scientists are not doctors". A complete waste of time.........! Competing interests: None declared |
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Shyam S Kothari, Professor of cardiology All India Institute Of medical Sciences, Newdelhi,110029
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......from keeping science before the art of medicine, good Lord, deliver us. Lord R Hutchison. Competing interests: None declared |
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Mr Malcolm A Buchanan, MRC/RCSEd Clinical Research Fellow Queen Elizabeth Hospital, Birmingham B15 2TT, Mr Paul IA McMurtrie, MB/PhD student, University of Cambridge
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Dear Sir, Doctors stand around a patient's bedside, reasoning a patient's diagnosis. If a doctor is performing his/her duties properly, then he/she will question through history taking and performing a clinical examination in a systematic manner. A hypothesis will thus be created to establish the said diagnosis. Further reasoning by the doctor will prompt the request of investigations. Subsequent analysis of the available evidence, handled according to a well-established protocol, will lead to the formulation of a diagnosis, and an appropriate management regime commenced. Scientists formulate hypotheses too, to test a particular thought process, in the same way as doctors have been taught to do. Scientists also follow protocols whilst performing their investigations. They assimilate the evidence acquired, and manipulate or deviate from these investigations to gain a clearer picture of the hypothesis being tested. Parallels between such benchside and bedside activities are hardly dissimilar. Perhaps there are more scientific persuasions amongst doctors than we cared to realise! Competing interests: None declared |
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Arun S Nanivadekar, Independent Medical Research Consultant C-2 Flushel Apts., 21 Road, Bandra (W), Mumbai 400050, India
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Dr. Richard Smith's assessment is the present reality, but this needs to change, and I believe it can. However, if most doctors were to have a scientific outlook, we need to make high science palatable to them. Besides, those who are inclined to acquire a scientific outlook need a nurturing support from administrators, health care managers and, most of all, from people themselves. This has been very well brought out by Sir David Weatherall[1] and Dr. Michael Brown[2]. These two essays are worth reading and pondering over for every doctor and health care manager. [1] Weatherall D. The conflict between the science and the art of clinical practice in the next millenium. In, Grossman DC, Valtin H, ed. Great Issues for Medicine in the Twenty-first Century. Ann N Y Acad Sci 1999; 882:240-46. [2] Brown MS. The making of a physician scientist: 2000. idem; 247- 56. Competing interests: None declared |
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Jane M LORD, Gardener SA38 9PR
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Dear Richard Smith, I found when I was a member of Ceredigion Community Health Council that most of the doctors I met [ my interests were the elderly, mental health and alternative medicine ] would say, when talking about most complementary healing, that they [the doctors] were different and more reasonable because they were scientists. I've been trying to figure out a really solid argument to that ever since. Now might be a good time: 1] docs think they're scientists but they are not very good at it eg no critical appraisal skills to speak of 2] they don't care how good they are yet lives are in their hands 3] their training is pathetic without a basis in scientific method and statistics and it encourages them to accept facts from establishment sources uncritically and discourages them from being open to ideas which are not orthodox. 4] they don't listen and have discarded the science/craft of assessing symptoms - like looking at one's tongue 5] they think they are right [ but can't be if the above points are true ] and become rude and arrogant if challenged in their judgement or sometimes even if asked to explain. 6] let alone check if the patient feels better after their intervention. Treatment of thyroid malfunction is a case in point and since it's becoming obvious that some 25% at least of the western population will turn out to be thyroid impaired [ that's why the American pharmacists reduced the limits for TSH last year because people were ill yet normal according to the current limits and the blood testers knew they were missing too many cases.] thyroid treatment is about the best case against the "doctor as scientist" that there is. Recent research into the role of T3 in treatment of hypothyroidism compared groups dosed with either T3 + T4 or T4 alone. [ Using T4 doses current in orthodox treatment.] Let me ask you scientific doctors out there what you should conclude if the groups turn out to be statistically indistinct? And that no improvement was the result that they shared? Wouldn't one of the logical [ science must only be logic in the end ] conclusions from the study be that current treatment is ineffectual? However the researchers concluded, when indeed the 2 groups' treatments were equally ineffectual, that the addition of T3 made no difference to well-being and therefore practitioners should carry on with the usual habit of prescribing T4 alone.[!!!!!!!!!] REFERENCE: http://www.thyroid.about.com/gi/dynamic/offsite.htm?site=http://www.drlowe.com/frf/t4replacement/intro.htm It's your house, gentlemen of the medical establishment, but you must get it into some sort of order soon. The organ that regulates metabolism [ ie the thyroid that regulates everything] is looking pretty sick throughout the whole population and we the patients are getting to realise that we are better equipped - as in critical appraisal skills- and informed - internet- than you. I for instance have a BA degree in experimental psychology which gives me a far better understanding of statistics and experimental methodology than any of my local GP's. And out on the Internet there is a growing and vociferous community that can and will insist on proper treatment. PS I seem to saying that doctors are quite redundant in the form they persist in taking: yes. PPS Unless I was in an road accident or some other emergency only, when I must admit that I would not want to be A&E'd by an aromatherapist…. But, back to Science: here's a thought and an url to connect to it: "Like religion, science isn't a unified set of principles: It's a bunch of politicized factions. So when you vote yes on science, be sure you know whom you're voting for." <http://www.alternet.org/columnists/story/18848/> Competing interests: None declared |
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Andrew H. Cutler, Biochemical consultant 3006 230th lane SE #X103, Sammamish WA 98075 USA
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Doctors may fall prey to misleading or even fraudulent proposed treatments if they do not understand science. Scientific theories must be consistent with all known reproducible observations. Observations are the only facts in science, theories are by denfinition not true - they are only not yet proven false. Observations include those made personally, anecdotal reports from reliable sources, and actual data when it varies from what was published. Some cases in point: It is unscientific to treat hypertension below 175/110. See Port et al. in the January 15th, 2000 Lancet. Original Framingham publications did not accurately report the data. The actual data is inconsistent with current treatment paradigms. Thus there is no possible justification for treating. Many companies sell "far infrared" saunas where the radiator element surface area is not large enough to be emitting the stated power in the stated spectral range. They do not explain why their claimed radiation penetration depth is greater than that actually measured and reported in the literature. It is not ethical to suggest a patient buy equipment based on technically innacurate sales literature. Many journal papers claim to draw a conclusion which their own numerical data do not support. E. g. the Hviid paper showing autism not being due to thimerosal in vaccines in fact does not statistically distinguish between the hypotheses that it does, or does not, at the 95% confidence interval. If science and technology are to be medically useful, medical training shall have to include some legitimate scientific education so that practicing physicians no longer fall prey to falsehoods dressed up in scientific mumbo jumbo. The easy way to do this is to change the requirements for entrance to medical school so that majoring in science or engineering is mandatory Competing interests: None declared |
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Brian Morgan, Freelance Journalist Cardiff CF11 6LF
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Does Ms Lohr's analysis apply to the medical practioners who made diagnoses of Munchausen's by Proxy (MSBP) when encountering patients with presentations they believed were fictitous or fabricated? Were they sufficiently scientific in their approach to seek better knowledge? Should there now be a quality audit involving all past diagnoses of MSBP/Meadow's Syndrome etc. and an automatic referral to peer assessment of the clinician involved whenever these words or similar are uttered? What about the cases currently working their way through the courts based on such an allegation? Why are these not being reviewed as a matter of urgency? Competing interests: I am now researching and being paid for a television programme based on this subject matter later this year. |
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Alfredo D. Espinosa-Brito, Calle 37 #5404, Cienfuegos 55 100, Cuba Hospital Dr. Gustavo Alderguía Lima, Ave 5 de Septiembre and Calle 51 A, Cienfuegos 55 100, Cuba, José M. Barmúdez-López
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Dear Editor: We carefully read the interesting Richard Smith editorial “Doctors are not scientists” (1) Is medicine art or science? This debate began in the Western countries 25 centuries ago and it continues today. (2,3) We think that clinical medicine is art and science. So, clinical doctor has to be, at the same time, artist and scientist if we want to fulfil both characteristics of our profession. The present clinician should not be a passive professional, receiving “the truth” from others (teachers, books, journals, scientific meetings, clinical guidelines, systematic reviews, etc.) that give “the truth” to him and he applies in his daily practice, based on his own “experience”. The scientific method is not only related with the biomedical research or clinical trials in Medicine, as it is suggested in the mentioned editorial (1) but also, and especially, with the clinical method applied to the patient care. (2-5) It is known that in all sciences there are many different particular methods, but there is a unique, general and universal method, which is applied to the completed cycle of all research because it is common to all sciences. This is the scientific or experimental method that was definitively elaborated by Claude Bernard in his book “Introduction to the study of experimental medicine”, published in the second half of the 19th century. (3) Clinics is a practical science, which is expressed in the final result of the medical care of one sick person. (research study n = 1). This type of science requires the knowledge of all components of the human process and its method. We agree that “a scientist is somebody who constantly questions, generates falsifiable hypotheses, and collects data from well designed experiments” (1) Precisely, this is the way of the clinical method, the correct thinking process for diagnosis, prognosis and treatment of a patient, when we actively intervene in the always new and natural “experiment” that represents the health-disease process of one person. (4,5) In the diagnostic process the physician goes from the concrete reality (symptoms and signs obtained by anamnesis and physical examination) to abstractions and to the concrete them in his thinking. Later, the medical doctor has to create his diagnostic hypothesis, and after he indicates lab and imaging studies for its confirmation or rejection. (2) The prognosis is also an inherent condition of the modern science. It is always probabilistic and complex. Here, clinical medicine needs the assistance of social medicine, epidemiology and health statistics, with the focus on the individual health problem. (2) Decision making and therapeutics are the last part of the clinical method, going to the active contemplation to action, and from identification and knowledge to transformation until it is permitted by science and individuality of each patient. (2) This step has to combine the best available evidences (science) to solve each case and the best clinical expertise (art). However, the reality is not always acquired in this methodical way. A long time ago it is known that in some situations, intuitive diagnosis can also catch the reality through a synthetic and comprehensive judgment, and this ability is part of art and humanities. (2,4) We can assure that the scientific-technological advances of the last 60 years mainly changed the technique, but not the clinics. (4) Furthermore, Clinical epidemiology brought to medical doctors, in the last 30 years, new methodological tools for the evaluation of efficacy, efficiency and effectiveness of many diagnostic and therapeutic procedures that clinicians daily use with our patients, in order to improve the quality of care that we offer. (2,3) So, we can ask: Is it only science the quantitative one, the experiment, the randomized clinical trial? Where we put the logic thinking, the rational faculty and qualitative variables as life, happiness, suffering…? But all these aspects are frequently overviewed or discriminated. They are considered as “pseudoscience”, soft science or second class science because those variables can not be exactly measured and, therefore, they can not be evaluated with “scientific strictness”. (2,5) It is true that this type of qualitative research has been less developed among clinicians, and frequently it has culminated with a theoretical speech without efficient fruits to medical practice. This does not minimize its importance, but shows us its backwardness and the emergent necessity of its development, the only one way to make more humane our scientific clinical profession. Alvin Feinstein, one of the fathers of Clinical Epidemiology, looking for linking quantitative and qualitative approaches of clinical medicine, has created two classical terms: “Clinimetrics” and “iatrotherapy”. The first was a meritorious intent to improve quantitative measures based on clinical variables obtained in our patients, and the second, a qualitative complement of all different actions that we as physicians do, besides our “technical” activity. (2,3) Finally, we think that in spite of many “scores”, risk calculations, sensitivity, specificity, positive and negative predictive values, and many other tests, that would support our technical and scientific diagnoses and treatments, they will never fulfil all expectations of the patients as human beings, and that so called “art” of our profession will have the same, or maybe more value than in the past. We do not say that the medical doctor will not be a practical scientist, but we have to complement it with the solidarity and humane purpose of our work. Sincerely, Prof. Alfredo Espinosa-Brito, MD, PhD
References. 1. Smith R. Doctors are not scientists BMJ 2004;328 (19 June), 328.7454 2. Espinosa A. Medicina Interna, ¿qué fuiste, qué eres, qué serás?” Rev Cubana Med 1999;38(1):79-90. 3. Moreno MA. El arte y la ciencia del diagnóstico médico. Principios seculares y problemas actuales. La Habana: Científico-Técnica, 2001. 4. Ilizástigui F. El método clínico: muerte y resurrección. Rev Cubana Educ Med Super 2000;14(2):109-27 5. Rodríguez L. La Clínica y su método. Reflexiones sobre dos épocas. Madrid: Díaz de Santos, 1999. Competing interests: None declared |
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Robert A. Da Prato, Medical Officer Military Entrance Processing Station, 7545 NE Ambassador Place, Portland OR 97229
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A scientist, to me, is one who applies the scientific method, which, beyond basic empiricism, is collection of facts, creation of a hypothesis to explain the facts, and then (the step that is usually omitted because of reasons listed below) testing that hypothesis by using all your ingenuity to disprove it. Virtually everyone naturally does this provided money and ideology don't get in the way, which they do most of the time. Even a "scientist" who is a middle class wage earner falls victim to this, designing research to best satisfy the person who signs the front of his paycheck.Everyone,including "scientists," can be scientists when it is of benefit to them. You might like anchovies and you might like mint ice cream. You hypothesize that both together would be delectable to you. You test. You falsify the hypothesis. Science is easy. Although Einstein, in describing what a scientist does, stated "Above all, never stop questioning" it would be absurd to think physicians could embrace this essential quality of science since it would violate the money and ideology supremecy principle in their lives. Physicians' livelihoods depend on doing what is customary and usual ... the community "standard of care". Oh, like theologians of old, they can safely question how many angels can dance on the head of a pin, what kinds of dances would be appropriate, etc. but they could never question that angels exist. An example is in order here. Orthodox physicians, no doubt, argue all the time about vaccinations, such as what dose to use, what frequency and at what age they should be employed. But what do you think the professional lifespan of a pediatrician would be if he or she questioned the medical value of vaccinations in affecting the incidence of childhood diseases and refused to administer them? I knew one such pediatrician who, in the 1970's refused to give pertussis vaccine because of, in his opinion, its ineffectiveness and the morbidity and mortality associated with, possibly, the endotoxin component. He claimed he never lost a patient to pertussis but he definitely lost his license. Time has supported his views of endotoxin toxicity of the old pertussis vaccine, and I never forgot his argument for the ineffectiveness of vaccinations against childhood diseases(which I listed several days ago in another submission and I will repeat here in case someone can falsify it): "As for the benefit of vaccinations themselves I have never had the following observations answered to my satisfaction (and I have what must be everyone's personal bias in wanting to believe that vaccines work and are safe). One may view any almanac which lists the incidences of the major childhood diseases (such as measles, diptheria and pertussis) from 1900 to 2000 or the mortality from these diseases, and what is noted for all of them is precipitous declines in incidence, most of which (sometimes over 90%) occurred prior to the introduction of vaccines. And, of course, it would be absurd to think that whatever was responsible for the dramatic declines in these diseases prior to vaccination being used (such as, possibly, improvements in nutrition, sanitation, and climate control)would disappear the moment that vaccinations became available. I have to conclude initially that only a small fraction of, say, 10% of the reduction in these diseases were due to vaccination. But possibly vaccinations had no effect at all, since diseases with no mass vaccination strategy show similar decreases from very high to extremely low incidences over the century (e.g. typhoid). Since I do not believe an effect can precede its cause I can only conclude finally that, at least in the US from the period 1900 to 2000 and at least for the diseases noted, vaccinations had no effect on the reduction in the incidence or mortality of the major childhood dieases." So what's wrong with that reasoning? Actually, all physicians in practice use a modified form of the scientific method. As soon as the physician sees the patient walk in the door he is gathering data. More data from the history, developing and discarding hypotheses, testing them by directed questioning, physical examination, perhaps with imaging and laboratory work, and then the ultimate test, treatment. If the patient recovers this is evidence that the hypothesis and treatment were correct (Recovery also supports the dictum that the function of the physician is to safely entertain the patient while nature heals him, so one should avoid smugness). If the patient does not improve or worsens, though, the diagnostic and treatment hypothesis were falsified. The weakness of this approach is the range of hypotheses and treatments physicians are allowed to consider by their administrative and academic physician masters (who have financial and ideologic biases in spades). And above, all, the practicing physician must NOT question, must NOT be a scientist, in anything other than minor matters, not if he wants to get paid by insurance, not if he wants to keep his license. A few years ago a physician acquaintence, a good family doctor, in my opinion, "sold" himself to a large HMO-type operation. After six months he gets the first letter from the administrator suggesting he increase the frequency of his "patient encounters" but added, with eye rolling boilerplate, "that he should keep the same high quality of patient care he has demonstrated." All that means is less time with the patient and more pills. Administrator happy, drug companies happy, doctor probably not so, but he has complied. Patients, well, as long as it doesn't cost me much. Obviously, different areas in medicine are affected differently by the pressures to be a non-scientist. For those specialties with rapid confirmation of the benefits or dangers of intervention (e.g. any structural abnormalities such as caused by acute trauma, severe infections, major pain) medicine is more "scientific", (the hypotheses are more likely to be unambiguously tested). But for the rest of the profession... In my opinion, Dr. Smith is basically correct in his assertion. Competing interests: None declared |
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David L J Freed, allergist (private) 14 Marston Rd, Salford, M7 4ER, UK
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Three cheers for Richard Smith! It takes guts for a medical editor to disabuse his readers of their most cherished assumption, but it’s true. We doctors like people to think we know what we’re talking about, and may indeed be so convincing that we convince ourselves too. Because other people’s lives depend on it, we have a big emotional need to be right, and are uncomfortable with the thought that none of us really knows enough to be a good doctor. Even if we know everything that is known, we still don't know that which is yet unknown. Scientists, on the other hand, are very comfortable with the unknown, indeed it is their bread and butter. When scientists disagree there is no more at stake than the scientists’ amour propre, whereas medical disputes get rancorous because fowever in the background is the thought that the other chap is damaging patients. Science does not in itself make its practitioners haughty (in fact the contrary if done honestly), whereas medicine does. Most of the blame for that, I think, is because doctors get used to seeing other people undressed while they themselves are clothed. Once you have seen dukes and archbishops in their underpants they’re never quite the same again. Taken together it becomes ever so easy for us doctors to start believing that we know everything, and that makes us unreasonably unreceptive to new ideas. And that is the reason, Mr Editor, why medical journals must continue force-feeding original scientific studies to their unwilling readers. Competing interests: None declared |
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Eric J Will, Consultant Nephrologist St James's University Hospital, Beckett Street, Leeds LS9 7TF
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The pursuit of evidence based medicine is developed using scientific methods by anybody’s criteria, an insight reported by authors more than a decade ago (Russell IT and Wilson BJ, Audit: the third clinical science? Quality in Health Care 1992:1;51-55). This may be analysed so that, ideally, hypotheses generated from randomised, controlled trials in carefully characterised patient populations to determine clinical efficacy are applied to general patient groups to establish clinical effectiveness. The consequences are registered and inspected to see whether a variation of hypothesis is required before the next cycle of exploration. The loop is Hypothesis, Experiment, Outcome and Analysis. This is the basis of both individual patient management and the development of Specialities. The intellectual fatigue of unrelenting exposure to EBM rhetoric can obscure the kernel of truth, that audit is essentially scientific. Even at a national level of collaborative audit (for example the UK Renal Registry [www.renalreg.com]) much of this structure is implicit and inadequately respected, to the extent that the penultimate step is rarely accorded the time and resource required to wind on the activity and start the next creative cycle. It is important not to diminish the scientific elements of clinical activity, not only because medicine (particularly in the UK) has suffered enough denigration over the past decade, but because the clinical profession badly needs to find a sustainable strategic historical and cultural role in contemporary medical science and society. For example, the anticipated facilities of the national IT programme make much more sense (to ‘engage’ clinicians) if they are seen as enhancing the rehearsal of audit as a key professional attribute. A more explicit evocation of the audit cycle serves to validate both clinical practice at the level of the consultation and the wider development of the subject. To respect ourselves we have to respect our activities, preferably without a retreat into the shadowy ‘arts’ of Practice that we have little hope of characterising or measuring. Inadvertent but solid scientists, then, in the main! Competing interests: Secretary, UK Renal Registry |
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Marwan M Azar, medical student American University of Beirut
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While doctors may not be "pure" scientists per say, they are required to fully comprehend the mechanisms and laws of both the biological and physicial sciences and to appriopriatly exercices these laws. As a 4th year medical student I can safely say that i and many of my peers can both cite the 3 laws of thermodynamics, and solve differential, logarithmic and linear equations with ease. We can also tackle organic chemistry synthesis schemes and analyse evolutionnary events like speciation or drifts. Of course scientists are experts at these endeavors but it would be wrong to claim that doctors are incompetent in science. Most of them are competent in the fields of science and that is why i do consider them to be scientists at the core. Competing interests: None declared |
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