Medical academia is failing patients and clinicians
BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7546.863 (Published 13 April 2006) Cite this as: BMJ 2006;332:863
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Peter Rothwell is correct to point to the need for observational
clinical research, which is undervalued compared with basic research and
randomised clinical trials. Can I add a plea that granting bodies and
journal editors provide room for well researched and representative
clinical case series. Our capacity to describe diseases and their natural
history changes over time, with better diagnostic tests and improved
understanding of disease mechanisms. It is important that we have
contemporary descriptions of diseases and their outcomes. I am sure that I
am not the only physician who uses Google Scholar when I am on call.
Finding summmaries of treatment trials and meta-analyses is
straightforward when I am confident of the diagnosis. But when I am faced
with a diagnostic problem I sometimes resort to entering the symptoms and
signs into Scholar. It is not always helpful but sometimes I hit a
thoughtful case description that expands my thinking about the problem I
am struggling with. This will only work if clinicians have a medium in
which to share their clinical observations.
Competing interests:
None declared
Competing interests: No competing interests
Clinical research requires NHS time.
Peter Rothwell [1] argues that academia is failing patients and
clinicians. As one of the authors of the paper he cites demonstrating
‘enormous value’ (the first reliable data on risk of major malformations
due to antiepilepsy drugs in pregnancy [2]), he may be interested to know
that none of the co-authors (a varied mixture including Consultants, a
General Practitioner and specialist epilepsy nurses), have academic
contracts and are paid purely by the NHS. The research was enjoyable – the
difficult parts came mainly from the tedious ethical applications, and NHS
beurocracy, and apart from the epilepsy register co-ordinator, was done
mainly in our spare time.
Herein lies the problem - the ‘post new-consultant contract NHS’ is
primarily interested in seeing patients, not in research or education. I
spend large amounts of time outside my paid NHS contract on education and
research, but in my draft job plan, was recently presented with research
sessions scheduled from 08.00 – 09.05 on every 5th Friday – the three
hours and 15 minutes per year thus allocated is insufficient for trust
governance paperwork let alone organising or doing any research! None of
my colleagues were offered any research time at all. The NHS needs to
maintain a vision for the future [3], and if it were a business, would
regularly invest heavily in education and research, rather than as an
afterthought. It is not just academia (driven by a research assessment
exercise that rewards grant income and high impact factor science papers
and therefore unlikely to do clinical research) that is failing patients
and clinicians. Clinical research requires time and NHS clinicians may be
best placed to do it if they were given more.
References:
1. Rothwell PM. Medical academia is failing patients and clinicians.
BMJ 2006;332:863-4.
2. Morrow JI, Russell A, Guthrie E, Parsons L, Robertson I, Waddell R,
Irwin B, McGivern CR, Morrison PJ, Craig J. Malformation risks of anti-
epileptic drugs in pregnancy: A prospective study from the UK Epilepsy
and Pregnancy Register. JNNP 2006;77:193-8.
3. Morrison PJ. Colour vision. Ulster Med J 2006;75(1):1-2.
Competing interests:
PJM has 2 honorary personal chairs and an honorary readership from three UK universities but is paid by the NHS and not by any of the 3 universities.
Competing interests: No competing interests