Scientific Temperament in Clinical Practice
Dr Ghazal Tansir MD, DM (AIIMS New Delhi)
A freshly inducted postgraduate resident, Dr. Aziza, rushes inside the internal medicine ward on her night duty. Five new febrile patients have been admitted in a span of three hours as the epidemic of tropical fevers rages on in the city. Carrying the “sampling box” brimming with syringes, vials and some rapid test kits, she notices the blackened tips of the fingers of one of her patients. Bogged down by a heavy shift and the gloominess of a long night ahead, she began to read about this intriguing phenomenon. From that moment of inquisitiveness, culminated her first (and not the last) ever scientific paper, a case report on symmetric peripheral gangrenes in malarial infection.
As doctors manning busy wards and rushing to “finish” the outpatient clinics so that the long queue of two hundred patients could receive the treatment they were waiting for, research often takes a backseat. Yet, the scientific temperament should remain paramount in medical practice for us clinicians. Why, though? Especially why, in a resource-limited setting, should scientific temperament be inculcated? This is because of the uniqueness of the field we work in.
Medicine is the one domain which is an amalgam of the sciences and the arts. A doctor internalizes vast scientific concepts and combines them with intuition, experience, and compassion, resulting in the “art” of clinical practice. Thus, the knowledge and generation of newer scientific developments is the key that propels our field ahead.
A doctor must aim to be aware of “why” a particular phenomenon is occurring in their patient, rather than restricting themselves to just the management. It is indeed a different experience altogether when one manages a case where one is treating cerebrally and not spinally. As an oncologist, I am reminded of one of the consultants at my department who always insists on learning how a disease behaves right at the molecular level. As per him, this knowledge not only helps you treat the patient but also empowers you in knowing about the nature of this cancer and how it can cleverly bypass your treatments.
A doctor must aim to be aware “what” more they can offer their patient. There are times when standard treatments fail, and these are the moments when an open scientific mind can think out of the box. A doctor with a dynamic mindset will be ravenous to search for options available that can make their patients’ lives better. Again, my experience in the field of cancer treatment reminds me of my mentor who has an unwavering motivation toward going the extra mile for finding a solution for his patients. Seeing him in action, I realize that the world is very small in this current era for those with expanded minds. One just needs to have the right temperament for it.
The “what” and the “why” constitute the scientific temperament which make one’s clinical practice meaningful. Moreover, what greater thrill than ideating a study, developing a hypothesis, writing a protocol, carrying out a clinical trial, then seeing your ideas come to life in the form of a research paper. From Susruta and Hippocrates to Banting and Best, doctors and scientific temperament have been a unit since ages. In the modern era, when hemato-oncologist Siddhartha Mukherjee writes a literary gem like “The Emperor of All Maladies” and nephrologist Jason Fung decodes autophagy and fasting in “The Obesity Code”, their scientific temperament shines through.
Sometimes the circumstances may be averse to the generation of critical thinking. Yet, we must aim to keep on our thinking caps and retain the spark of a scientific thought process. I end with the example of my closest friend and colleague, who took on her solo shoulders the enormous responsibility of a double-blinded interventional randomized trial. Through the gruels of residency, she emerged a better clinician, researcher and academician – and that should be the ultimate aim.
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