In the December 2010 issue of JAMA, Robert Brook writes an essay titled "A Physician = Emotion + Passion + Science." In it, he makes the argument that we should use language that more engages the "right brain" in our discussions of science today.
He might be right about that to a certain extent. To be honest, I am a little conflicted on the point. Certainly, it can be hard to communicate exciting ideas in the dry passive voice of modern scientific writing. Perhaps a little panache would help, (although I might stop before putting a cartoon in the middle of a research article in NEJM.) At the same time, I think that there is a purpose to the detached voice of scientific writing. After all, when we publish our findings we are basically putting them out there to face the scrutiny of our colleagues and our community. There is something to be said for a world in which we mostly "let the facts speak for themselves" in this initial presentation, and save our more passionate debates for other venues. A not-so-small part of me that believes that using precise, if dry, language and a specified format in the publication of research results is more than a necessary evil, but a strength of the scientific process. Perhaps we need not to change the presentation of research findings, but create a new venue to allow for the discussion of the work and the debates that an exciting paper can so often precipitate to take place in a more clearly defined public forum. That is, preserve the integrity of the presentation of results, but also provide a venue and a broader audience for the passion and excitement (and disappointment) that those results can provoke. It's certainly something to think about.
But regardless of his point, some of Dr. Brook's reasons for making it are both depressing and downright wrong.
The article contains the following paragraph: "Not very long ago… Each patient was an individual with a family and a community. Each physician was an individual with a small amount of technology at his or her disposal. Every patient required a different art of care, whether it was the way the patient was touched by the physician or the manner in which experiences were shared or questions were asked. Without available or sufficient health insurance, physicians and patients had to work together to produce treatment plans that were consistent with the patients' culture and socioeconomic status and that reflected the patients values about the kind of care that they wanted and did not want."
Anybody out there want to tell me why on Earth that paragraph is in the past tense? Brook's argument is that as technology has improved, care has become increasingly standardized, and that this standardization has led scientific communication becoming "standardized, emotionless and dispassionate." But I think (hope, pray) that this past tense idea of even remotely personalized medicine is downright false. Admittedly, I'm a long way away from being a practicing physician, but I hope that every treatment plan I come up with, for my entire career, is consistent with the patient's culture and reflects the patient's values about the kind of care they want or do not want. Nobody, physician or patient, should find anything less even remotely acceptable. And while it is nice to imagine that in the beautiful modern world of insurance, we no longer have to consider the patient's socioeconomic status, or the cost of treatment options, in reality, not doing so is beyond irresponsible and will only cause both the patient and the system further harm. Dr. Brook's putting a personal doctor-patient relationship into the past tense, dismissing the modern need for custom designed personal care, and awareness of the cost, is something of a tragedy, but I don't think it has anything to do with the dry language of scientific papers. Thankfully, I can't think of a single one of my colleagues that plans to practice this "standardized, emotionless and dispassionate" form of medicine that he seems to think is all we have left.
Dr. Brook goes on to say, "It is difficult to imagine a young physician growing up in this communication environment, trying to focus his or her brain on science studies that seem to be written in a language as foreign as medieval English would be to modern inhabitants of the British Isles." Now, I am currently struggling with the writing of a scientific paper, and I will be the first to admit that the language doesn't always come easily, and that I am writing for a specific audience. I've often told my husband and my mother that they don't have to prove they love me by reading my scientific articles. Still, if they did make an attempt, I assure you that they, all of you, and all of the other "young physicians" I know, would have a far easier time reading "Disrupted reinforcement signaling in the orbitofrontal cortex and caudate in youths with conduct disorder or oppositional defiant disorder and a high level of psychopathic traits" than The Canterbury Tales in the original. I would like to believe that those of us that have chosen the field of medicine don't need a gimmick to focus on the science for a little while, and I hope that most of those that have preceded me into the field will give us a little more credit than Dr. Brook seems willing to.
So yes, perhaps we could enliven medical research with a little more emotion. I'm all for putting the debate and discussion that is the most exciting part of science into a public forum and letting the people that care passionately about a topic teach us all.
I'm even more for making the time in the medical school curriculum to have emotions and passions outside of the raw science that we all must learn, and it seems like that may be where Brook is hurting. It's not the flaws of the dry language of the modern scientific paper that he is telling us about in this essay, but perhaps a deeper feeling of being unable to express his emotions in the modern dialogue of medicine. To be honest, I feel a little sorry for him. At the same time, I'm pretty sure that the answer isn't more emotional imagery in my next paper.
I may be spending a lot of my time with the dry language of science at the moment, but I hope that the emotion and passion that brought me to medicine will help keep my experience from being what Dr. Brook seems to see. This upcoming week will be spent drafting a paper (and reading dozens of others), but I'm confident that I will be able to focus on the task at hand, cartoons or no, even if I do have to sign of facebook and focus on the "foreign language" of Chaucer, I mean Neuropsychopharmacology, for just a little while.
This essay refers to: Brook RH. A Physician = Emotion +Passion +Science. JAMA. 2010. 304; 2528-2529.
