Intended for healthcare professionals

Rapid response to:

Editor's Choice

Doctors are not scientists

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7454.0-h (Published 17 June 2004) Cite this as: BMJ 2004;328:0-h

Rapid Response:

Clinicians as inadvertent scientists?

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

Competing interests: No competing interests

30 June 2004
Eric J Will
Consultant Nephrologist
St James's University Hospital, Beckett Street, Leeds LS9 7TF