Why Medical Doctors are not Scientists …
Whom should we go to for advice …
Whom should we trust
Yucalandia’s content is usually focused on facts, figures, observations and advice on how to best apply them. This article is a distinct departure from this approach, and as such I offer this article as a series of my personal insights and opinions – as expressed on Linked-in’s burgeoning science forums.
For context, the associated Linked-in public forum discussion can be found at:
“>What qualities and qualifications make someone a scientist?”
Typical responses consisted of posts like:
“About qualities ? could be curiosity and perseverance…
About qualifications?…with ethics training…I think ”
“Love of truth. Hunger for understanding. Patience. Determination. Independence. ”
After some reflection, I considered these to be relatively thread-bare offerings or thin soup, lacking substance. That left me pondering the contents of the Linked-in threads on Climate Change and other “scientific discussions” on the web. As my focus shifted to the surprising number of poorly crafted and poorly constructed replies by supposed “scientists” on various Linked In forums, I realized the question “What qualities and qualifications make someone a scientist?” required more than a few tweets or more than even a recitation of the definitions of the scientific method. The insights of others, and requests that I explain my initial cryptic short replies, led to ruminations expressed in the following series of on-line replies and dialogue:
Here are my first attempts communicate with the Twitter-generation:
… “It is interesting that the same attributes listed by some posters also describe a good kindergarten teacher or a bright 3 year old.” …
…” If one essential quality of a good scientist is the ability to make and describe accurate and thorough observations, then a some posters here on Linked-in routinely miss the mark. A good definition and good description would seem include qualities that rule out Kindergarten teachers, dentists, physicians, et al. ” …
A different poster queried:
… “I don’t see how a doctor can be a good diagnostician if he/she cannot analyze a probem and define it and the solution. The same with a dentist. A good kindergarten teacher would have some of the same skills, but not apply them as often. The assemply line worker, the bricklayer, the coalminer, I would not say have these qualities. ” …
…” Please Mr. Steven Fry , tell us … ¿What qualities and qualifications make someone a scientist? ”
~ ~ Hint: When asking another fellow to pull the stopper from his jug, we know not what sort of draught he will pour. ~ ~
Steven Fry • In theory Peter’s approach sounds reasonable, but does not fit common medical school education practices in the past 30 years. As a prof at 2 different universities with roughly 2,300 students, I and the other faculty members routinely found that pre-med students nearly universally are interested only in memorizing what is needed to “pass the test”, resisting attempts to get them to think critically. This bias towards memorization vs critical thinking or creative thinking gets reinforced in US medical schools. This reality has been confirmed in repeated discussions by the head of Mediical Education at U of Kentucky Med School, the head of Residency and Research at U of Richmond Med School, and the head of educating physicians to work with patients at Univ. of Rochester’s Med School.
I mention these points as a part of the discussion to add – well-developed critical thinking skills – to the list of qualifications for a good scientist. Advanced problem solving requires a strong foundation of facts, a fine well-trained analytical mind, adherence to disciplined & thorough approaches, and both critical & creative thinking skills. Dentists & physicians are routinely taught to memorize large quantities of information and then taught mechanistic approaches to applying them. As a result of the general overly-narrow pedagogical approaches used at most modern medical schools, there are a group of specialized programs at places like McGill University’s Med School intentionally designed to buck the trend of US Med schools, by intentionally training their physicians to do the opposite. They instead focus on how to think, focus on how to be good detectives to sleuth out underlying causes, & and focus on how to solve problems vs. the routine 12-minute-office-visit approach that most physicians learn.
Good scientists take the time to observe and determine both the symptoms of a problem, & also attempt to determine all the root causes. Since most physicians take a history, diagnose, & then prescribe treatments in under 12 minutes, their own practices prove that they are not scientists. Dentists are generally also very highly-trained highly-specialized technicians focusing only on mouths, getting in and out quickly – both focusing almost exclusively on “one-and-done” approaches.
How many physicians do independent self-directed research?
How many dentists do independent self-directed research?
This leads to another quality of a good scientist. Good scientists not only formulate hypotheses & alternate hypotheses, they also develop & execute plans to prove their hypotheses, to explore & potentially rule-out alternate hypotheses, and they continue to investigate the loose ends that inevitably result from research. Good scientists determine the repeatabililty, reliability, precision & accuracy of their results. Good scientists use both positive and negative controls to limit Type I & Type II errors, and attempt to determine the systematic and random bias(es) of their results. Read Daubert, Carmichael, and Kumho for formal broadly accepted current guidelines for these approaches.
Doctors generally diagnose, prescribe meds, & send the patient home in under 12 minutes per patient. If they hear no more from the patient, they generally go on to the next 200 patients. Doctors and Dentists generally make no efforts to determine the precision and accuracy of their results. They do not attempt to determine their Type I & Type II errors, nor do they attempt to use positive & negative process controls.
If you still disagree, please consider one troubling result of physicians’ non-scientific practices: One study of autopsies of patients who died of terminal illness in US hospitals with no random autopsy policies, found that roughly 65% of patients had their terminal illness incorrectly diagnosed and improperly treated. Two decades of studies have shown that physician error and hospital error unnecessarily kill 75,000 – 125,000 US patients per year. These things are direct evidence that, in general, physicians are not scientists.
These are just a few of the qualifications and qualities that distinguish good scientists from Kindergarten teachers, bright 3-year-olds, medical doctors, dentists, lawyers, et al, from the list of people who broadly qualify as good scientists.
An insightful independent British scientist (“Doug Cross”) thoughtfully responded:
” Charles Darwin did not have a Doctorate, the supposed ‘entry-level qualification’ for sicnetists. But he had the qualities described by Steven, and the ability to communicate his ideas in a society that had rigidly entrenched religious views about evolution that were directly opposed to the implications of his work.
I always told my students that if they wished to become scientists then they had to learn to communicate – otherwise, they should follow a different career path. Facts – vast quantites of them – can be found in textbooks and research reports, but it is the little anomalies that you trip over in ‘the field’ – the ones that will not go away, the ones that are not supposed to be there – that are the starting points of new understandings. If you learn to spot these, and then have the courage and doggedness to pursue them, worry them to death and then, finding they are still there, to tell others, be they scientists of not, what you believe you have found in a simple and convincing manner,, then THAT is what makes you, eventually, a scientist! ”
Doug’s description of tripping over anomalies and my earlier posts hint at the importance of well-honed and well-disciplined observational skills in good scientists. Other posters spoke of “imagination, persistence, curiosity, high ethics, intelligence, perseverance,” etc.
Incomplete observations that miss key elements are like thin soup. The qualities listed above are certainly all good and necessary in scientists, but are seriously incomplete. Applying Set Theory can be useful in determining the critical properties of a particular group of interest: Recognize key qualities and qualifications by identifying the unique items that differentiate the area of focus/intent from other groups.
This raises the importance of describing yet other key differences that distinguish good scientists from Kindergarten teachers, bright 3-year-olds, physicians, lawyers, & dentists and other non-scientists: The latter make lots of observations but they generally do not look for broad patterns and trends between their patients or clients, nor do they then form hypotheses about the root causes of those patterns and trends. If typical non-scientists do sleuth out patterns and trends and form hypotheses about their causes, few then go on to form research plans, and even fewer complete detailed investigations (real research – where research is NOT just Google-searching) nor do they then form and report conclusions.
When considering anomalies, patterns, and trends, an interesting seeming paradox arises here that further distinguish scientists from other inquisitive minds. The three items (anomalies, patterns, and trends) may appear internally juxtaposed. Patterns and trends individually potentially point to broader underlying rules or principles, while the anomalies can be equally important in revealing important apparent exceptions to said rules or principles. Still, anomalies may point to yet undetermined icebergs of further significant countervailing principles or rules. Consider the progression of understanding of Darwin’s principles, meshing with simplistic understandings of genes, then beliefs in DNA’s controlling roles, followed by glimmers of understandings using Molecular Genetics lenses, all of which may be significantly modified and even partially overturned by realizations from Epigenetics. (Layman’s Intro to Epigenitics) While Lamarkianism was vigorously rebuked and rebuffed by scientists a century ago, it is now poised for a robust resurgence, since the simple methylation of a one individual human’s single gene can eliminate the expression of a supposed master controlling gene for 25 – 100’s of subsequent generations. The DNA remains, but it’s blueprints are never executed. I offer this as a modest example of how small anomalies can ultimately broadly trump patterns, trends, rules, principles, and grand theories.
It takes a good scientist to both recognize AND manipulate this melange of anomalies, patterns, trends, rules, seemingly conflicting principles and grand theories – and then branch out into further investigations of the intricacies and interactions between these items and also explore the interactions with yet other related rules & principles.
Clearly, Kindergarten teachers, bright 3-year-olds, physicians, lawyers, dentists and other non-scientists do not possess or express these qualities.
Can anyone out there come up with a beautifully crystallized “sound-bite” that describes the complex scientific method that encompasses the recognition, pursuit, determination, and blending of the progression of patterns, trends, rules, anomalies, and then further recognitions and resolutions of seemingly conflicting principles and grand theories?
To my simple mind, there are other qualities and qualifications not yet described here that differentiate good scientists from Kindergarten teachers, physicians, bright 3-year-olds, lawyers, dentists and other non-scientists.
For those who did not catch the previous whiffs of personal bias, I appreciate Popper’s perspectives on proving or disproving hypotheses, theories, etc by solely using positive evidence – while ignoring critical elements that differentiate the proposed idea from co-mingled or competing elements or groups/sets.
This iceberg’s tip points to a need to further expand our list of qualities and qualifications of scientists to include yet more qualities and characteristics like: The quality of not remaining content to cackle over our “latest discovery” of a mound or hillock, while peaks that tower over us remain yet unrecognized and unexplored.
By prematurely trumpeting minor or even misleading “discoveries”, so-called “scientists” have successively undermined the public’s trust in science over the past 4 decades of repeated “discoveries” that are later relegated to irrelevance or refuted or even overturned. Witness the confusion that arises over dueling “experts”, especially where rates of Type I & Type II errors are neither characterized nor invoked – like Climate Change. (more on this below)
Next: Think of 3 to 5 dimensional simplex modeling that characterizes maxima and minima of complex responses while inadvertently ignoring major canyons and towering peaks.
This quality of good scientists might be described as the ability and practice of looking beyond our current data, results, and convenient conclusions. This quality encompasses more than the curiosity of bright 3-year-olds and physicians, it goes beyond to include a hunger for knowledge and understanding, coupled with disciplined continuing investigations.
Kindergarten teachers, physicians, bright 3-year-olds, lawyers, dentists et al tend to take one-and-done approaches. Quick observations, quick mechanistic diagnoses, rapid application of previously learned principles or facts are not science: Observe, Diagnose, Treat… NEXT! … Observe, Diagnose, Treat… NEXT!…
Fortunately, good scientists go beyond “treating” or “solving” “the problem” of the moment.
I continue to bash away at these issues, not to bully people, but instead to address the critical issue of how the Press, (especially Big Media), and society in general mistakenly misidentify who are actually qualified to accurately comment on scientific issues and policies, personal health issues, Public Health and even medical issues and policies. Big Media and society generally listen-to and inappropriately trust medical doctors, lawyers, pseudo-scientists and other non-scientists as their sources of information – because scientists have done a poor job of identifying and publicly claiming our unique and important role in creating well-functioning societies and a high functioning human race.
When even supposed scientists making comments on Linked-in cannot recognize the differences between actual scientists vs Kindergarten teachers, physicians, bright 3-year-olds, lawyers, dentists et al, then it shows how far from reality we have drifted as a community from knowing who we really are, knowing what is truly important, knowing and implementing our role in the world, and seemingly not actually knowing our own craft.
When so-called scientists trumpet results or insights or findings, when they have not characterized the variability or reliability or accuracy of their findings – they do the entire process harm – like with Climate Change. When so-called scientists fail to investigate and characterize competing explanations, and instead prematurely trumpet their “latest findings”, they harm the world and discredit the rest of us – which is why I frequently point to discipline and integrity.
Based on hundreds of comments on Linked-in’s “science” forums: It is clear that Scientists still need to identify whom we are, what makes us unique, how to practice our craft, what roles we need to play in society, and what things we should avoid.
Discussions like this one help identify key errors in thinking, judgment, and perception – where inappropriate and incomplete perceptions are brought to the fore – batted about – allowing informed consensus to emerge.
Thoughtful thorough analysis and appropriate definition of “what the actual problems are” *, executed with integrity, precision, and accuracy … are not-frequently exercised hallmarks of a good scientist – leaving the current community of scientists with more than a few demons to be exorcised…
No wonder ordinary people, society, Big Media, and politicians have great difficulty in knowing whom to turn-to for trusted and reliable advice and insight into complex problems and many of the major issues of the day.
*Asking the right question, focusing on the actual problem or critical aspects of a problem, and then doggedly pursuing and thoroughly characterizing the results/solutions/conclusions are aspects of being a good scientist.
**Twitter, tweets, Google searches, highly-redacted sound-bites, and half-baked insights should not replace detailed rigorous scientific analysis and thoughtful dialogue.
We are better-served by efforts like Einstein’s 6 years of quietly toiling, rejecting, reforming, refining, and polishing of General Relativity than many current modes of scientific exposition. Consider the Italian scientists’ recent tweets about exceeding the speed of light, which was nothing more than an anomaly of an experimental error – which quietly and gradually diminishes and undermines confidence in the rest of us scientists.
Said another way: Good scientists do not rush to judgment … or tweeting.
Our mills grind exceedingly fine.
I now yield the floor to others.
**Appended Note: Linked-in’s forums have a limit on the number of characters allowed in each post, so, the Linked-in versions of these posts have some explanatory clauses excised to meet their website’s limitation. The versions listed above are fully fleshed-out, including the excised bits.
Arrrgh… like a swamp-full of creeping crawling slithering critters – yet more beasties have stuck their noses out of the darK – causing me to offer a few more insights into what qualifications and qualities make a good scientist:
Good scientists also have the ability to examine other people’s data and results, and go beyond the frequently apparent observations and superficial conclusions. Good scientists are able to recognize data that have been redacted, and results that have been misunderstood, manipulated, massaged or cooked.
As the technical head of an analytical laboratory, I had the opportunity to review our lab’s data from 100’s of DOD, DOE, and private industrial sites, along with the results from other laboratories collaborating on the same programs and processes. While examining data, it would occasionally become apparent that there was more going on than what was presented in tables of results and in figures. We talked of “sniff tests”, but there was a clearly intuitive process that took place that recognized when things were “off”. In the absence of other test results, imagine a simple Oil and Grease numerical result, that triggered a trip back to the dessicator holding the vials of dried residues. The single suspected residue clearly was an ionic inorganic salt, with no organic components at all.
Next, imagine a graduate student who uses successive (inappropriate) applications of a t-test to excise “outliers” from his larger data set, ultimately excluding 80% of his data, just to get the outcome he desired. As he presented the data in a group meeting, two other students intuitively smelled a rat, and called “foul”. The poor soul defensively held-out for 15 minutes, not realizing that single lenses invert the images, persisting because he really did believe that his data manipulations were legitimate.
(For novices, never use a t-test this way – and only judiciously use Q-tests on appropriately large data sets.)
If the reader wave’s this off as so much trivial twaddle, consider the years of falsified data that came out of a Saint Louis laboratory, the years of falsified data that came out of a Phoenix AZ laboratory, and similar efforts from a Pensacola FL lab.
Hundreds of professional so-called “scientist” government auditors – who were actually little more than well-trained technicians – blessed these fraudulent results for years, due to mechanistic analytical approaches. I and other experienced scientists who had seen the same bits of these data that the government “scientists” had approved, instead intuitively (and quietly) called “foul”.
If there had been just one truly qualified and empowered scientist examining the data from each of these 3 laboratories, there would have been very 100’s of very different environmental cleanup and remediation decisions made by the end-users.
Again, I need the help of others to neatly summarize and describe this set of intuitive qualities: seeing beyond what is on the printed page – instead recognizing the underlying realities – qualities possessed by fine scientists.
Science must begin with myths, and with the criticism of myths; neither with the collection of observations, nor with the invention of experiments, but with the critical discussion of myths, and of magical techniques and practices. The scientific tradition is distinguished from the pre-scientific tradition in having two layers. Like the latter, it passes on its theories; but it also passes on a critical attitude towards them. The theories are passed on, not as dogmas, but rather with the challenge to discuss them and improve upon them.
K. Popper, “Conjectures and Refutations: The Growth of Scientific Knowledge” (Harper & Row, 1963)
And yes, there is more than a bit of grey in my beard.
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Thanks for that interesting article. (Not being good at reading lengthy pieces on the computer, I’m going to print it and study it further.)
The “scientific method” is so important to our everyday analyses of problems, suggested solutions and such; so I applaud your piece. I recently saw an interview by Fareed Zakarria of Daniel Kahneman, who has written: THINKING, FAST and SLOW. I haven’t yet read it, but I sure will. I suspect you’d like it as well.
Thanks for your inputs. I first became attracted to your blog with your comments in defense of those of us who have language learning difficulties. (Yes, I even have a new book on that subject–if only I could keep up with all this reading!)
Continuing on the theme:
Scientists are conjecturers by nature. Like their hypotheses & theories, all scientists are inherently fallible. The testing and refuting of hypotheses and old theories are the paramount qualities of scientists and the scientific process. When a scientist’s ideas or theories, new and old, survive refutations and testing, they are shown to be more correct and therefore closer to reality &, approaching truth.
Science differs from pre-science in two fundamental ways. Both pass on their theories, but science passes on questioning and critical attitudes towards theories. Pre-scientific theories are passed on as dogmas, while science embraces the challenge of evaluating and and improving them.
Do medical doctors, bright 3-year-olds, dentists, Kindergarten teachers et al who know and occasionally practice the scientific method, also regularly participate in the testing and refuting of others’ hypotheses and existing theories?
Or are they more focused on promoting and following scientific or medical consensus ?
If you like these perspectives, check out some of Karl Popper’s perspectives on the difficulties of proving theories.