|Year : 2014 | Volume
| Issue : 3 | Page : 263-265
Beyond professional parochialism: Path to progress
Department of Community Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||18-Mar-2014|
Department of Community Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Banerjee A. Beyond professional parochialism: Path to progress. Med J DY Patil Univ 2014;7:263-5
If we browse through any issue of a contemporary medical journal we will find that technological advances drive interdisciplinary collaboration among doctors.
For instance, if we take the current issue of this journal, Paranjpe and Mane in their guest editorial have brought out how meticulous planning and communication between the anesthesia and surgical teams are mandatory for the successful outcome of surgery for patients undergoing laryngotracheal resection and reconstruction.  The same point is made by Bajwa in his case report on management of difficult airway during laryngectomy and thyroidectomy. 
Similarly, Shetty et al.  in their review article describe the attainment of a new vision through combined osteo-odonto-keratoplasty procedure which involves collaboration between ophthalmologists, dental surgeons, anesthesiologists and other medical professionals.
However, just a few generations ago, surgery before the discovery of anesthetic agents was a harrowing experience for patients. It was infrequent and was carried out when all other measures failed as an act of desperation. In medieval Europe, surgery was often performed by barber surgeons as performing surgery was considered beneath their dignity by physicians. 
In the year 1846, Morton a Boston dentist used ether as he removed a tumor from a patient's jaw.  This event was a major advance in anesthesia and surgery. Doctors were motivated to specialize in surgery compelling barbers to restrict their practice to haircuts. In the early period following Morton's demonstration, the doctors most conversant with the technique of anesthesia were the surgeons since there were no doctors specifically trained to administer anesthetic agents. They in turn, delegated the task of administering anesthesia (usually ether) to their operating room nurses under their supervision. Nurses thus became the first professional group to administer anesthesia. However, when with more regular use, adverse effects including deaths due to anesthesia were recognized, the concept evolved that doctors were the key to medical safety which together with newer discoveries of anesthetic agents and techniques gave rise to the separate discipline of anesthesiology.
The teamwork between anesthesiologists, surgeons and other related disciplines has driven advances in surgery and patient care. However, doctors need to move beyond their parochial professional network and collaborate with professionals from other disciplines beyond medicine to bring about further progress. Let us consider for example the present working relations of most medical researchers with statisticians.
Just as surgery was left to the barbers in the pre-anesthetic era, in the present day most medical researchers, who have little statistical knowledge, leave the statistical analysis of their studies to statisticians, who have little knowledge about medicine. It is the blind leading the blind in a somewhat distorted version of "double blind" study! The end result of such an association may well be a series of meaningless calculations. 
Doctors who are not well versed in statistical theory tend to interpret the results of significance tests uncritically and even incorrectly. Similarly, most statisticians do not endeavor or are unable to gain the required insight into the research problem or its clinical relevance.
The interpretation of results of statistical tests in medical research requires more than just knowledge of statistics. It requires insight and understanding of the research question and its clinical relevance, which will be lacking if there is a communication gap between the clinical researcher and the statistician if both confine themselves parochially to their respective disciplines.
The situation is reminiscent of the early days of barber surgeons when there was no common meeting ground between the barber surgeons and physicians who in their parochial mindset considered it beneath their dignity to perform surgery, which was brutal in any case before the advent of anesthesia. Many a clinical researcher under the impression that statistics is not their concern, hand over their data to the statistician who then performs "third degree" on them until they generate the much sought after "P value."
On the other hand, whenever medical men and women avoided the parochial mindset and ventured beyond their narrow specialties they have been able to bring about a paradigm shift in medical thinking. A couple of example will illustrate this.
Florence Nightingale, as well as being an exceptionally dedicated military nurse, was also a brilliant statistician. She used statistical arguments to back her claim that improved hygiene led to higher survival rates in battle casualties. Today Florence Nightingale is best known as the founder of modern nursing. However, it can be argued that her lifelong campaigning for health reforms based on statistical evidence had an even more significant impact on healthcare. 
The research on smoking and lung cancer was conducted by Sir Austin Bradford Hill and Sir Richard Doll, who had complementary backgrounds.  Austin Bradford Hill had wanted to become a doctor, but a bout of tuberculosis made this impossible, so instead he pursued a more mathematical career later specializing in medical statistics never forgetting his first love. Richard Doll was keen to major in mathematics at Cambridge, but he got drunk the night before his entrance examination and underperformed, so had to settle for a career in medicine under persuasion from his father. The result was a pair of men with strong interests in each other's discipline which complemented their study on exploring the association between smoking and lung cancer which required knowledge of both medicine and statistics. Their path breaking research established smoking as a risk factor for lung cancer against the prevailing medical consensus of the time.
These deliberations suggest that dual insights are needed to push the envelope. Medical researchers can take inspiration for acquiring statistical sense, akin to common sense, both essential for research, from a number of contributions made by doctors in furthering understanding of statistics as applicable to clinical and public health research. These are contributions made by doctors for doctors. ,,
Statistical Methods for Anesthesia and intensive care  is written by two practicing anesthesiologists. One of the authors besides being a specialist anesthetist has done his Masters in Public Health (majoring in advanced statistics and epidemiology). The other author, also a qualified anesthetist has completed his BSc in statistics. This dual insight in both anesthesia and biostatistics has enabled both of them to bring out a lucid and user friendly book which will appeal to all clinicians pursuing research.
Similarly, Primer of Biostatistics by Glantz  now in its seventh edition has been written by a professor of Medicine and a non-communicable diseases researcher, who has had no formal training in statistics. The book is in print for over three decades testifying to its popularity. Illustrative examples and challenging clinical problems, culled from recent medical literature, highlight the discussions throughout the book and facilitate a more intuitive approach to biostatistics among clinicians. By combining whimsical studies of Martians and other planetary creatures interspersed with actual papers from the medical literature, the author makes statistics fun and enjoyable. An added advantage with this book is the companion CD-ROM which can perform more than thirty statistical tests of data commonly encountered in clinical research.
Lastly, Making Sense of Data by Abramson and Abramson  one a public health physician and the other a family physician, now in its third edition, is a self-instructional manual on the interpretation of epidemiological data relevant to both public health practitioners and clinicians. These authors have also developed a statistical software, WINPEPI which is in the public domain and freely downloadable from the web.  This free software can perform hundreds of statistical tests used in public health and clinical research including, sample size calculation, validation of scales, meta-analysis and so on.
These few examples of doctors contributing to biostatistics may perhaps dispel the inhibition and fear of statistics among most of us, even inspiring some to develop a separate discipline of medical statistics tailored to the needs of public health and clinical research.
| References|| |
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