Clinicians vs. Scientists:
Understanding the Limitations of Both and the Importance of Working Together
The general public perceives clinicians, such as medical doctors and scientists, to be interchangeable—clinicians are scientists. While this can be true, a more nuanced understanding and appreciation for the differences between clinicians and scientists is important. Understanding the general differences will help to empower you in your healthcare choices and will enable you to be more discerning about dubious claims that you may see floating around online.
Clinicians are those people with practice degrees and training in patient care. Examples are medical doctor (MD), doctor of osteopathic medicine (DO), physical therapists (DPT, MPT), registered nurse (RN), doctor of dental surgery (DDS), etc. Those with practice degrees are rarely provided with more than an introductory education on scientific concepts. Instead, education and training focus on direct patient interaction and care.
Scientists are those people with degrees and training in scientific research (e.g., immunology, molecular biology, biochemistry, research methodology, statistics). Examples of relevant degrees are doctor of philosophy (PhD), doctor of science (DSc/ScD), and doctor of public health (DrPH). Those with research scientist degrees are typically only provided with limited education in practice and patient care when it is within the scope of their scientific field. Clinicians can be scientists but it takes training above and beyond their academic credentials to become a scientist. Similarly, scientists can be clinicians but it also takes additional training.
Clinicians work with patients on an individual level. Clinicians are trained in diagnostics and treatment. They are trained to ask clinically-relevant individual questions, understand which tests, labs, or imaging may be relevant, and which procedures may be helpful in achieving a diagnosis and treatment plan for a specific patient. They are trained in subspecialties that allow them to understand the typical progression of a specific condition or disease and the different options available for treatment.
Scientists conduct research to advance knowledge in a specific field and study populations, whether that be cells in a Petri dish, microorganisms, non-human organisms, or humans. Scientists are trained in research methodology and statistics. They understand how to design studies and experiments to maximize rigor, minimize bias, and identify and perform the relevant statistical tests that reveal the results of their study. Scientists are responsible for studying a very specific area that may help to create new diagnostic tests, improve treatment options by finding/creating new ones, and studying the disease characteristics at molecular, tissue, organism, and population levels.
Both clinicians and scientists are expected to communicate. Clinicians are expected to communicate to their patients about the tests, procedures, scans, etc. that are ordered for them, why they are ordered, and what to expect from the tests, procedures, scans, etc. Scientists are expected to communicate with the public (e.g., other scientists, media, etc.) about their work—discuss the relevance, possible implications, and limitations.
The Importance of Translators
Translators make the world go round. Without them in our ever increasingly connected world, relevant information, research, culture, etc. would stay encapsulated within its original language, left to be discovered and/or created anew by each respective culture. Similarly, it is important to society that we have people who understand both patient care and research and can translate the necessities of both. These are the people that help to make timely advancements in healthcare possible. They bridge the bench-to-bedside gap. For example, they can identify gaps in care and help to brainstorm what may be important for a new line of research to consider (e.g., how clinicians tend to use diagnostics, the barriers that patients tend to face, etc.). They can also identify potential opportunities for research that clinicians alone or scientists alone may not.
According to an article in The Journal of Pediatrics addressing the importance and necessity of clinician scientists:
A clinician scientist who deeply understands a disease, its complications, and implications may raise specific questions and develop focused research projects, which can be more effectively translated into clinical benefits. Being a clinician scientist may…promote bench to bedside research projects, linking basic and clinical science. Physician scientists have the capability to transpose clinical observations into testable research hypotheses and translate research findings into medical advances.
Additionally, in an article in Nature Cancer,
The ability to take a patient-focused problem, distinguish what is merely interesting from what is clinically useful and then address it with the highest-quality basic science is a crucial skill that must be passed on to the next generation of cancer researchers.
While both of these quotes came from journals dedicated to medical subspecialities, they speak to the importance of clinician scientists across all areas of healthcare. There is not an area of healthcare that does not benefit from those who are cross-trained as clinician-scientists and can translate between those with a clinical perspective and those with a research perspective. We as a society are better for having people who understand both. Clinician scientists are in high demand and unfortunately, there are very few of them.
In the absence of that, it is critical for people to understand the roles of clinicians and scientists separately, and that they should be working together, not in opposition, to drive science and medicine forward.
COVID-19
Few people mistake a person with a PhD for a medical doctor. However, it is a common misunderstanding that people with practice (clinical) degrees have been trained in the fundamentals of science and research, because most have not. During the pandemic especially, it has become commonplace for clinicians to be interviewed in the media and labeled “expert” when asked their opinions on scientific research.
The COVID-19 pandemic has offered numerous examples of clinicians entering into conversations about scientific research who lacked the relevant credentials and/or training but were treated in the media narrative as though they were experts. Many of these examples highlighted had serious conflicts of interest as well.
Dr. Oz promoting hydroxychloroquine or any of the other supplements and herbal remedies that he has recommended through his television show throughout the years, completely outside the scope of his surgical practice and expertise.
The fringe group America’s Frontline Doctors pushing ivermectin as a treatment for COVID-19, spreading misinformation about the pandemic, and specifically spreading anti-vaccine misinformation and rhetoric.
Joseph Mercola spreading misinformation about COVID-19 vaccines and being identified as a super spreader of misinformation who also profits off of the bad information that he spreads. There are so many more examples. The danger and damage that have been incurred through clinicians stepping outside of their realm of training and taking advantage of the misunderstanding of their training has made combatting the pandemic increasingly difficult around the world.
Clinicians, and in the above examples physicians specifically, engaging in public discourse about areas of research that they are not familiar with should give everyone pause. For the same reason that you wouldn’t want a person with training and education in bench science, such as chemistry, performing open-heart surgery, we should be wary of asking clinicians to provide their opinion on scientific questions and then labeling them as “expert.” Doing this has caused confusion and it is easy to see why. People look to experts for a reason. We hold them to a higher standard. We give their opinions and information more weight in our decision making; therefore, it is especially important to understand how their expertise applies to the situation at hand.
Clinicians and scientists are both necessary. Experts with training and education in both areas who can act as a translator are rare. It is important for everyone to understand the broader limitations of clinicians and scientists so that we do not ask them to step outside of their zone(s) of expertise. It also empowers people in providing better comprehension and a path for more informed healthcare decisions and consumption of information.