The Value of “Small Science”

“Let me tell you about an interesting case.”

“I’m having trouble with a patient, can I get some advice?”

“Help, my patient is dying on me and I cannot for the life of me figure out what’s wrong.”

“While caring for this patient, I learned something kind of cool last week.”

Have you or a colleague uttered such things in the past few days, weeks or months? Throughout my own clinical practice in an academic setting these types of utterances happened on a daily basis, if not many times a day, albeit sometimes merely under my own breath.

It is a fact that we physicians, even the smartest among us, still have a lot to learn, and vice versa, have a lot to teach through such experiences. Our clinical practices are sometimes influenced (usually for the better) by prominent, well-funded, randomized clinical trials, but more often it is the humble practical knowledge learned from one another that separates the satisfactory from the great physician. In my chosen specialty of neurosurgery, I have observed that there is not two or three bits of knowledge that make for a great operation. Instead the best surgeons have a grab bag of literally thousands of largely undocumented tricks (patient selection, choice of instrument, anatomical insights, manual skills, techniques, etc.), which make for their success. Much of this knowledge continues to get acquired the old fashion way – via trial and error in the trenches of medicine. Amazingly, in a world of more than 5,000 medical journals we all too often find ourselves repeating one another’s mistakes and relearning lessons previously learned by others. Why is this?

I believe that the above situation stems in part from a medicine-wide failure to formally acknowledge the true value of practical knowledge, or what we at Cureus like to refer to as “small science.” In many ways this is illustrated by how most medical journals see their mission, especially those with a coveted high impact factor. For example, the Instructions for Authors section in JAMA is almost half the length (in words) of Joseph Conrad’s the Heart of Darkness. Filled with complex guidelines for statistical processes and data reporting, the focus is on academic researchers who themselves are focused on climbing the ranks of academia as much as they are the knowledge at stake. The complexity of such processes, and even the associated financial costs in open access journals, intimidates too many of the busiest practicing physicians who have amazing clinical experience and insights but lack the time and arcane knowledge of contemporary journal publishing processes. As an Editor-in-Chief of Cureus this strikes me as a tragedy; some of the most knowledgeable clinicians have no forum for passing on their hard-won insights.

Our mission at Cureus is to use technology and a new philosophy of post-publication peer review to strike a better balance between process and the more efficient reporting of valuable clinical science. Our goal is to make it easier than ever for busy physicians in the trenches of medical practice to document the important things they learn on a near continual basis. Ultimately if some clinical observation is important enough for an overworked physician to invest time in writing up, we at Cureus are delighted to help with the task.

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One thought on “The Value of “Small Science”

  1. Yes! I would love answers to my Brain injury. I have discovered that the Brain is undiscovered. No worries. It will be a relief to actually see Neuro Scientists studying the BRAIN without $$$ from a grant. A vast amount of hidden information is presented.

    GO, GO, GO into the vast expanse!

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