Having a foot in both camps and generally loving both groups, I sense an unhealthy straining of relationships between clinicians and scientists in rehabilitation. Where once clinicians dominated conferences and the literature, the field is nearly all led by scientists. Both scenarios are unhealthy and out of balance.
Let’s be one sided for the moment and have a dig at the scientists:
It has been said that “research is like motherhood – there is no such thing as an ugly baby” (Greer 1987). Of course, researchers want to validate their choice of subject and world view, but aware clinicians see scientific arrogance emerging in some quarters, of proclamations of what to do in the clinic by clinically immature researchers, they note research niche protection at conferences at any cost, or often becoming an expert on all matters. Many scientists openly state they hate talking to clinicians. I see dangers of research protocols driven by data and PhD factories rather than idea and experimentation emerging from clinics and I see the ghastly and paradoxical situation where some clinicians feel they have to do a PhD to be someone!
Clinicians see the methodological bastardry of their tenuous clinical ideas even if research based, (e.g. Johnson et al 2012) and they do wonder sometimes “why on earth was that researched”. Reports of scientific misconduct LA times don’t help and as clinicians often can’t access the journal articles unless they are open access, a kind of firewall has been placed between them and science (as an aside see the guardian)
In medicine the decline of the clinician scientist is often lamented – the percentages of MDs getting NIH research funding compared to PhDs has decreased sharply and there are worries that few scientists have a deep understanding of clinical problems.
In the rehab professions however, I believe and hope that the clinical scientist is just emerging. The features of a clinical scientist range from active and wide readership, integration of science to clinical behaviours, guideline following, data collection and research collaboration. But this clinician researcher divide could limit this. The divide exists in all health professions and one result is that research translational problems remain and much beaut research sits in the “valley of death”(Roberts, Fischhoff et al. 2012) never or belatedly to see the light of day and the use and uptake of clinical guidelines is minimal. And how many clinicians read just one paper in their association journal?
Of course, it is not just the scientist or their system which may be at fault here, despite my one way attack – I know that many do it tough. We’ll discuss clinicians later and we tend to have a go at them all the time anyway. The issues here could be dealt with here by the recognition of the potential of the growing clinical scientist group in rehabilitation, encouraging them and including them. It has to be a win-win situation.
Some suggestions for scientists:
- interview at least three clinicians who are using the techniques or strategies researched. Ideally interview the originator of the idea if it came from the clinic. This may have an impact on methodology and outcome measurements
- be involved in translational research. Did your paper have an effect, what is the basic knowledge of the target audience, advise those who construct guidelines
- include a clinician in the team if appropriate – they like names on papers too and can be very helpful in the discussion section and have often worked extremely hard at reasoning an idea or technique.
- Clinicians love review papers.
- Never be frightened to talk to clinicians. Clinicians and scientists – ultimately one won’t exist without the other
Finally, a big thanks to all scientists for your contributions to date.
Johnson S et al (2012). Using graded motor imagery for complex regional pain syndrome in clinical practice: failure to improve pain. Eur J Pain 2012 16: 550-561
Greer, A. L. (1987). “The two cultures of biomedicine: Can there be consensus.” The Journal of the American Medical Association 258: 2739-2740.
Roberts, S. F., M. A. Fischhoff, et al. (2012). “Transforming science into medicine: how clinician scientists can build bridges across research’s “valley of death”.” Acad Med 87: 266-270