There is more to medicine than 'publish or perish?'
Nada Anzak
Guest Writer
Has the publication process become a vehicle for our own personal gain more than the good of our patients? Are we, as part of the international medical community so eager to broadcast our knowledge that we are at risk of compromising our primary duty, the care and concern of our patients? The time and the financial investment involved with clinical research are undoubtedly great, in any case.
In a recent talk delivered to students at UCL, Dr Fiona Godlee, Editor of the BMJ highlighted how the overwhelming desire to present positive findings in the research arena has led to an alarming number of instances of manipulation of data and dishonesty in reporting results. Thus it could be seen that the pressure to publish threatens to undermine even the most basic ethical principles of the healthcare profession, eroding the moral integrity of the work they do.
During the time I spent at a hospital in Beijing, however, I was fortunate enough to meet one doctor who, in his own small way, sought to change the research world’s perspective on seeking international fame through publishing. The son of two of China’s most celebrated surgeons, it quickly became apparent to me that Dr Hu’s sole focus was on the people he worked with and the community he served. Despite the fact that he was pioneering a specially designed retractor which could potentially change the face of routine vitreo-retinal surgery, it was clear that he and his team had no desire to produce a peer-reviewed paper from it. For Dr Hu, every element of his practice was about seeking spiritual contentment, the elemental joy of passing knowledge down from person to person, hand to hand, a principle seemingly at conflict with the flash and fame of the publication process.
Whilst the profound devotion of these doctors deeply impressed me, I could not deny feeling that without such emphasis on international publishing and expanding the global frontiers of medical knowledge we would be taking several large steps backwards in our efforts to alleviate health burdens. So how do we realign our personal pursuit of world-wide recognition with the elemental spirit of altruism behind all avenues of medical research?
The solution to such a problem is likely to involve continual reflection, and reassessment of our motives. The trouble is that reflection in medical practice in the West has come to be synonymous with the dreaded audit and clinical performance, at arms with the deeper reflection that would allow the fine balancing between personal motives and the ethical principle of benevolence we are bound by.
As I sat there sipping my steaming Chinese tea in the surgeon’s lounge I could not help thinking of Hippocrates and his oath that lies at the heart of all medical practice in the West. Whilst we have certainly progressed a long way from the idea of conforming to a singular, ethereal role, requiring the eschewment of all those primitive desires that make us human, the fact that the pulse of this revered oath is still palpable in medical practice today suggests we have not entirely lost touch with the spiritual nature of our profession. It is likely that tapping into these principles that unite the medical community will yield the answers to some of the fundamental questions of readdressing the nature of medical research.
‘Perhaps I am the only one in the world with this perspective?’ mused Dr Hu as we waited for the next patient to be wheeled in, as the stirring airs of traditional Chinese music filled the room. As I sat in his company, I had the feeling of being beside someone at great peace with himself, a rare quality in medical professionals in the West. From observing his interactions with his patients and colleagues the profoundly comforting influence of this factor was self-evident. One thing is for certain, integrating such an approach to serving the global community on a research platform will prove an even greater challenge.
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