For doctors in China, the relationship between clinical practice and scientific research has been a long-standing topic. At present, many hospitals in China emphasize that doctors should not only do a good job in clinical work, but also do a good job in scientific research, requiring clinicians to apply for topics, publish papers and other indicators, which leads to an embarrassing situation that clinical and scientific research cannot have both.
National scientific research is real: personal interest? Hard indicators?
Almost all the clinicians involved in the discussion work in tertiary hospitals, and most of them have the title of deputy chief physician or above and are qualified to guide graduate students. More than half of them publish more than 3 papers every year on average, all of which are in SCI or Chinese core journals. Many people have presided over or participated in many research projects, including the National Natural Science Foundation, clinical drug verification, and major national special research. And the project funds are as high as 20 million. Ironically, however, no one chose "I am more interested in scientific research".
All doctors said that hospitals and departments assigned doctors the task of publishing papers; Even if the hospital does not require it, there must be a certain number and grade of papers for the promotion of professional titles. So doctors are busy with clinical work during the day and do research and write papers at night. Only in this way can they stand out among their peers. This process is very hard. Professor Gu Feng, who has just published a paper in the top medical journal New England Journal of Medicine, said: "We have published this article for a year and a half, and every author will spare at least 8 to 10 hours every two to three weeks to constantly revise the article."
Dr. Zhang Qiang also said: "When I was young, I was a desperate saburo in clinical and scientific research. When I didn't ask to publish SCI articles, I could write six articles in China Brand magazine a year, and there were many topics. It's a pity to sacrifice the time you should have taken care of your family. "
Of course, some doctors expressed dissatisfaction or opposition to scientific research and papers: "I am a surgeon. As long as I can find information, I can integrate the experience of others and do my duty as a doctor." Yu Ying, who just jumped out of the system, said, "I hope everyone can do something that interests them and can improve themselves. If you think scientific research is helpful, do it. But if I just do meaningless and wasteful repetitive research for promotion, I won't do it for me! "
How does paper travel under the baton?
Because scientific research and papers are linked to the professional title evaluation and promotion system and the hospital grade, the hospital overemphasizes scientific research, and almost all doctors have experienced the pain of being forced to apply for topics and write papers.
Scientific research for the sake of scientific research will inevitably deviate from its original purpose. The research direction of many large hospitals in China is biased towards basic fields. On the one hand, these studies seem to be "higher" and it is easier to apply for project funds; On the other hand, many top SCI magazines now favor papers in this field, and it is easier to produce high-level articles by doing basic research. As the general trend, many professors directly focus on the level of gene detection and molecular regulation.
However, the basic research level of most clinicians is not very high, and they are often willing but unable. In the course of the project, they often encounter all kinds of difficulties, and rarely have smooth sailing. The vast majority of graduate students really participate in the implementation of these projects. In order to ensure that the project can be completed as soon as possible, many graduate students spend almost three years in the laboratory, and the time for clinical training is getting less and less. Many graduate students don't even have a basic perceptual knowledge of clinical work after graduation. How can such medical graduate students become good doctors?
Excessive pursuit of project funds and papers will inevitably lead to the proliferation of fraud. During the discussion, many doctors said that they had seen cheating in experiments or papers. Once the project is applied, it must be completed on schedule, otherwise the funds will be fully recovered, the paper will not be published, and there is no way to promote it. Under strong pressure, some people are forced to choose fraud. A professor said that his project has never been faked, but it is "very difficult".
A good project needs a lot of people and energy, but the number of papers that can be produced and published is limited; Some hospitals only recognize the first author and correspondent author in the process of professional title evaluation and promotion. In order to achieve the hard targets of scientific research and papers, some doctors have to "find ways" through other channels, resulting in the prevalence of buying and selling papers in recent years, forming an industrial chain of paper fraud, and its rampant degree is shocking. What's more, some doctors openly claim that what money can do is nothing at all. It is no exaggeration to say that this system that overemphasizes scientific research and papers has played a subversive role in the scientific research ethics of China medical industry to some extent.
Clinical scientific research, neglected landscape
Although doctors are dissatisfied with the national scientific research system, many people have found a shortcut. Many doctors say that real clinical research is the need of evidence-based medicine and the ladder of medical science progress, and they are more willing to conduct clinical related research.
Chen Jingyu, vice president of Wuxi People's Hospital affiliated to Nanjing Medical University and director of thoracic surgery, introduced his own experience: "My SC 1 paper is mainly about lung transplantation, with five articles before and after. The first SCI is a case report: there are only two cases in the world where left donor lung is implanted into right chest to treat pulmonary fibrosis; Lung transplantation for pulmonary tuberculosis. These papers have caused a good response internationally. " In foreign countries, many doctors will write papers and publish them in professional journals as case reports when they encounter special cases in clinical work. For example, the New England Journal of Medicine, as the top periodical in the medical field, has opened a medical record column of Massachusetts General Hospital since 1953. Massachusetts General Hospital makes a special case every week for peers to exchange and learn. The content often involves many disciplines and majors. Up to now, more than 3 160 cases have been published, which is of great help to improve the knowledge and technology of clinicians. Although almost all the doctors who participated in the discussion thought that the case report was of great reference value, only 76% doctors said that they would write special clinical cases as case reports. The main reason is that many hospitals in China do not realize the value of case report in the process of professional title evaluation and promotion.
Many doctors think that SCI papers can't just be made in the laboratory, and high-level papers can also be published in clinical research. The key is thinking. China is never short of patients. For a certain kind of disease, rigorous clinical research and long-term follow-up observation can also make a lot of "valuable" content. Some doctors choose to cooperate with drug clinical trial institutions, which they jokingly call "a bloody road", without administrative background resources and solid basic subject background.
It is also a wise choice to write what you like. In clinical work, many doctors have their own special interests. Summarizing these aspects will not be very painful and boring, but a pleasant thing. A neurologist said, "A while ago, we wrote a review for a magazine, and I was very interested. I work around the clock with my American friends to write it. Although the impact factor of this magazine is not high, I think it is particularly rewarding because it is' I wrote my heart myself'. "
Of course, there are also persistent explorers. Sheikh Yinjia's team has just obtained the registration licenses of nine allergen preparations from the US Food and Drug Administration, which is the first time in China's history to register allergen preparations such as pollen. In this regard, she is quite emotional: "Good clinical research requires long-term investment and can withstand loneliness. Our scientific research projects are all aimed at solving clinical problems. What the country wants is the registration certificate or new drug certificate of the Food and Drug Administration, not the SCI article. For these studies, our team has been working hard for 12 years on the basis of predecessors' work, all of which are carried out under the condition of tens of thousands of patients' outpatient service every year. A short-term and effective SCI evaluation system will mislead the direction of scientific research. "
The scientific research model has been criticized repeatedly. What is reasonable?
Halfway through the discussion, someone suddenly spoke: "Do you find that even in our group discussion, we can't avoid this custom?" We use the number of SCI articles and the amount of funds to measure our own' cows are not cows', which invisibly become the identity tag of doctors. Objectively speaking, there are no methods and indicators that can objectively evaluate clinical ability in China, which is worth pondering. "
It is true that it is difficult to objectively evaluate the clinical level of every doctor in reality, and how to evaluate "chief physician" and "deputy chief physician" according to the current model is even more problematic. In foreign countries and Taiwan Province Province, there is no such professional title evaluation system for doctors, and there is no pressure to write papers, so doing scientific research depends entirely on interest. There are only two levels of clinicians in the United States. After completing residency training, becoming an attending doctor is the highest title. They are free to choose to work in a hospital or open their own clinic. The abnormal professional title evaluation system is the real root of the problem that it is difficult to give consideration to both clinical and scientific research.
During the discussion, almost all doctors admitted that they would consult relevant literature when they encountered difficult problems in clinic. This also shows from another angle that if clinical work encounters problems that need to be solved, more results can be achieved if these problems are handed over to the scientific research team for research instead of taking up too much clinical time. Looking at the famous doctors abroad, their clinical level is very high. Although they don't spend every day in the laboratory, they often have their own research team behind them, or they can work closely with excellent research teams. Through a clear division of labor, they gave full play to their respective advantages and achieved impressive clinical or scientific research results.
Seeing that the practice mode of foreign doctors is more reasonable, Zhang Qiang decided to practice freely. He said frankly: "My freelance practice will better help me improve my academic level. In the future, if my ability allows, I will definitely hire or seek the cooperation of top international scientific research teams. Clinical and scientific research personnel are separated, each performing its own duties, communicating and coordinating. This is my ideal scientific research model. Beijing United Family Hospital provides 25,000 yuan for each doctor to go abroad for exchange. Private hospitals and public hospitals attach equal importance to doctors' academic exchanges, and they are more reasonable and standardized. "
Without the free-flowing medical market and the mechanism of patients voting with their feet, scientific research and SCI papers naturally become one-sided and easy-to-calculate indicators. The unreasonable distribution and evaluation system of scientific research benefits can easily become exploitation by clinicians. Zhang Qiang thinks: "Strictly speaking, many department directors in China are good resource integrators, not excellent researchers. This is a phenomenon in a special historical stage. With the opening of the medical market, the nature, purpose and theme of scientific research will change. "
In modern medicine, clinical and scientific research are two sides of the same coin, which are integrated and inseparable. A good doctor's clinical and scientific research level may not be neck and neck, but he must not neglect either side.
The doctors who participated in the discussion agreed that which is more important at present, clinical and scientific research, is rooted in the centralized system of medical resources implemented for many years, which leads to the lack of formal training and education for doctors. Various clinical and scientific research indicators promulgated by administrative departments at all levels have virtually become tools to restrict and exploit doctors at all levels. The system of centralized medical resources will not change, and the long-standing contradiction between clinical and scientific research will never be improved. However, in this big environment, doctors still have to face up to the pressure of scientific research and papers and find a way that is more suitable for their own situation, because what doctors can do is to try to change their own environment on a small scale, and the degree is quite limited. More often, they still have to adapt to the current social environment.