A good clinician and a good researcher?
As a researcher with a background in clinical pediatrics and working as a clinician, I am often perplexed by the complexity of modern biomedicine. Instead of being intimidated by the progress of basic science, we should in my opinion be in awe of the vast possibilities we have at our disposal to tackle the problems we face in the clinic every day. To use the buzzword currently practically required in successful grant applications, a translational approach combining bench and bedside research has never been more feasible than today. At the same time, medical training provides a researcher with relatively limited skills in laboratory medicine. It is therefore most often the case that clinician researchers are compelled to shed their illusions of omnipotency and collaborate with various experts in a true interdisciplinary fashion. By no means do I mean to imply that clinician researchers cannot or should not educate themselves in biomedical research, quite the opposite. Nonetheless, a multi-faceted approach is most often achieved by a team of scientist from a variety of complementary disciplines. (Read more)
The role of the clinician researcher in a multidisciplinary team is often to coordinate the research efforts and particularly to point the direction to answering clinically relevant questions. Our training and experience as clinicians is unique in giving us insight to what needs to be studied – others may be more apt to provide the answers. Frequently, in a meeting with collaborators – microbiologists, immunologists, geneticists, biochemists, biostatisticians, bioinformaticians and what have you – I feel ignorant and even superfluous since there seems to be no subject matter that someone in the room does not have a profoundly better understanding of than I do. But then I start to wonder what would be the point of having these meetings if that was not the case. In this fruitful setting it is wonderful to ask questions, formulate hypotheses, plan experiments and interpret data – that is given we understand each other. It is my experience that often the clinician researcher – the jack of all trades but perhaps master of none – is the person providing a common ground upon which the different specialized views of the more technical disciplines could meet. And hopefully this meeting point is somewhere in the vicinity of the clinical problem. Only in this sort of a communication and collaboration framework can we expect to discover reliable scientific answers to clinically relevant questions.
The flip side of the coin is naturally to ask whether a scientist may also be a good clinician. Years ago I was told by an esteemed surgeon that every minute spent holding a pipette is a direct reflection of the time spent not holding a scalpel. This view implies an antagonism between conducting research and clinical skill. Be that as it may, scientific literacy, or the capability of critically assessing published data, is a prerequisite for practicing evidence-based medicine. As the great William Osler put it, it is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it. It is my experience that nothing teaches one to search, read and critically assess scientific papers like writing and publishing a couple. (Unfortunately the opposite does not seem to hold true, reading a few papers does not teach one to write a good report.) Thus, at a minimum, active involvement in research may improve the clinician’s skills in searching and evaluating evidence. But I should like to think there is more to it. I am inclined to believe that a passion to become a better clinician and to acquire new tools to diagnose, treat and prevent disease inspires great clinical and translational research. On the other hand, the insight and cutting edge knowledge, not to mention the rigorous and creative thinking stemming from scientific research, is likely to be of benefit in the clinic as well. I am beginning to wonder whether it is possible to be a great clinician without being a researcher.
The fear of clinician scientists becoming a dying breed has been expressed several times over the last few years. Perhaps nowhere else is the marriage of clinical skill and judgment to scientific rigor and creativity more needed than in pediatrics. On the other hand, the research environment in Finland, even given the financial austerity of our time, still makes possible conducting high-quality clinical research and collaboration with excellent basic science laboratories. In this context it is our duty to continue to strive for scientific progress and practice evidence-based medicine to the benefit of our patients.
Samuli Rautava, MD, PhD
University of Turku & Turku University Hospital