Physicians are also scientists

DEAR DR. ROACH: My college kid went to a march for science. What does it mean to be a scientist? I thought she wanted to be a physician. Are physicians scientists?

ANSWER: Scientists are committed to making observations and finding ways to measure what they see, formulating a hypothesis and finding a way to test their ideas. Physicians do that. Further, the definition of “scientist” includes someone learned in science, and so a physician absolutely is a scientist.

Traditionally trained physicians learn the basics of physics and chemistry, biology, biochemistry and molecular biology, and later, anatomy and physiology. This leads to a basis for understanding health and disease, and allows us to be ready to understand clinical medicine.

Although there are exceptions, most physicians are not investigators, who are creators of science for the sake of increasing knowledge. Practising physicians use science to help others, and hopefully teach it to the next generation in some fashion. Many physicians also will publish unusual or instructive cases in the medical literature.

Advances in medical knowledge come largely from the investigators, less so from the practitioners. We need both in our society if medicine is to advance.

I hear a lot about the art of medicine, and I agree that there are practitioners who are very skilled in dealing with people and who have creative ways of approaching clinical problems. However, the physician-as-artist cannot exist without being a physician-as-scientist first, in my opinion.

I congratulate your daughter on her desire to consider a career in science, including medicine.

DEAR DR. ROACH: I read that studies show that, in the United States, mental and behavioral disorders reduce normal life expectancy and account for 13.6 per cent of the decrease in disability-adjusted life years. How is such information useful to and used by mental health professionals, and what does it mean to someone who is diagnosed with one or more of these disorders?

ANSWER: Mental health and behavioral disorders are indeed an important cause of mortality (premature death) and morbidity (disease, or any medical condition that reduces quality of life).

A “disability-adjusted life year” or a “quality-adjusted life year,” looks not only at years of life lost due to death, but also the effect of poor physical or mental health.

This is not a surprise to mental health professionals, who spend their professional lives taking care of disorders like depression and anxiety that have harmful effects on people’s lives.

One complication of depression is suicide, a common cause of death at all ages. Mortality risk can be decreased, and quality of life increased, by proper treatment of these mental and behavioral disorders, both by primary care physicians and by specialists.

I think your letter is significant because many people don’t realize how important and pervasive these diseases are. I still have patients tell me that they are told to just stop feeling depressed, or are advised about wellmeaning treatments that are wholly inadequate to the severity of their disease.

There remains a stigma to admitting that one is suffering from one of these conditions. I hope your letter can motivate someone to come in for treatment.

You can start with whomever you are comfortable: your regular doctor or a mental health professional.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.