Clinical academic medicine: a Socratic dialogue

Introduction

As in all walks of life, clinical academic medicine has many vested interests, some acting for the greater good, some not. Socrates has a penchant for sniffing out pretension and sectional interest. Hippocrates is a thoughtful, gentlemanly physician unaccustomed to ensnarement by Socratic wiles, and when he and Socrates meet one day in the marketplace in Athens the following conversation about the state of clinical academic medicine ensues. It is not a dialogue for the timid.

SOCRATES: Hippocrates, you are looking rather down in the mouth. What's up?

HIPPOCRATES: I am having a sabbatical from my clinical labours to spend time thinking about medical academic and scientific matters.

SOCRATES: How interesting. I had always thought of you as a proper doctor, not an academic one.

HIPPOCRATES: Sometimes, Socrates, you can be so wounding. How can I explain to you the difference between an everyday hardworking physician in service and one who, while active in clinical work, also has an obligation to teach and by original research to forward his subject?

SOCRATES: Are not research and practice compatible?

HIPPOCRATES: To some extent they are. Indeed, those who are not labelled “clinical academics,” if they are enthusiastic clinicians with a love of order, can and do study their patients and make important and useful contributions to practice.

SOCRATES: How does that differ from the sort of research you do?

HIPPOCRATES: I have always been interested in the molecular causes of disease.

SOCRATES: What use is that?

HIPPOCRATES: Without such understanding, there can be no rational progress towards treatments and cures as yet undiscovered.

SOCRATES: Do you use the word molecular in the same way as the disciples of Watson and Crick?

Prepared minds seeking innovation

HIPPOCRATES: Not entirely. Although their special science of molecular …