How to do research and still excel at patient care

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Welcome to another episode of the Clinician Researcher podcast. I am Toyosi Onwuemene, and excited to talk to you today about how to do research and still excel at patient care. So I was recently at a national conference and moderating a table talking about tips for grant writing, and one of the trainees at the table asked, well, what do you do when you really love patient care, but you still want to do research?

1:28 I don't want my patient care to suffer because I'm doing research. And you know, that question really resonated with me because we're clinicians. We love to care for patients. At least most of us do. We used to, until burnout and disappointment set in. Many of us really, really love to care for patients, and I actually argue that most of us still do. And we usually come to a career as a clinician because we enjoy caring for patients and we enjoy taking care of them and meeting their needs. And over the course of our training, we get to do it really, really well.

2:11 What we don't get as part of our training is research training. And even if you did a PhD, you didn't get as much research training as, say, your PhD colleagues. And every time you have a patient care role, in general, you're not able to have as much time spent doing the research that's needed. And so I do think it's important to think about this. Medicine's what seems like a dichotomy between research and clinical care, but it's really a false dichotomy. The reality is that both support the other.

2:51 The state of medicine as it is today is much improved because of research that has happened over the years. And the state of medicine is what it is because there's more opportunity for research. And so research and clinical care really do go together. Clearly, they don't always reside in the same person, but I do want to speak to five reasons today why doing research makes you actually a better clinician. Now one thing I want to go back to, and I say often to you clinician researchers who are listening, is that it really does take time to do research well.

3:34 It takes time to learn to do research well. This is the reason why, or for this reason. People are professional researchers. I talk about PhD colleagues all the time. Their whole training revolves around learning how to do research well. And it takes them a minimum of five to seven years to get that PhD that says, I now know how to ask a question and answer it and move projects through whatever their area of specialty is. And then people go on to do post-docs, and post-docs can last as long as five to seven years. More research training.

4:14 And so when a PhD is done with all of their research training, you tally that together. That's about 10 and sometimes up to 13 years of training just to do research well. And so it takes time to do research well. And as clinician researchers, or as clinicians who aspire to research careers, you need to understand that investment is needed to do this work well. Clinical training is different from research training. And clinical questions are different from research questions. And so, yes, if you are going to really take this seriously and move your career forward as a clinician researcher and be someone who leads a research program, you do need to make the investment of learning how to do it well.

5:11 Over time, you're going to have a team that's going to support you in doing this well. But you, as the fearless leader, need to have the resources that you need to do this well. And so don't think of it as my clinical care will suffer while I'm investing all this time and energy into learning to lead a research program. Think of it as enhancing your clinical care. And you enhance your clinical care in five ways. The first way is you learn to ask better questions. So leading a research program is about figuring out a way to take something that's huge and complex, a real big problem, and boiling it down into very, very, very small pieces, so into one of its small components, and then figuring out a way to answer, to test a hypothesis.

6:09 So it's like, if I do this, what happens? If I do this, will I get this result? And it's a yes or it's a no. And so you're able to set up experiments that help you answer the question. And that's why it takes so long, many, many years, to really make a significant impact because you're answering small questions each time. What it does is it trains you to really ask and test hypotheses. And in clinical care, sometimes that is what we're doing. I mean, we're never doing research on the patient. But we are asking questions. This patient's blood pressure is high.

6:50 If I give this medication, which is the first line recommended medication, will this lower the blood pressure by 10 points or the systolic blood pressure by 10 points? You're asking questions better when you can really narrow down a very clear outcome that you're going to measure to tell you that you have success or you don't have success. And to some extent, we already do this as clinicians, but we are able to do it so much better as researchers. And it really helps us to say, well, these are the outcomes that I'm going to measure. This is the timeframe in which I'm going to measure the outcome.

7:32 And based on the results of the outcome, this is how I'm going to respond. So it does help you ask better questions. And it's important to ask great questions because amazing discoveries come from asking questions. And sometimes as clinicians, we get so busy. We're just trying to work through the schedule. And it doesn't feel like there's time to really sit and think about the patient. But the more you are involved in research, the more gaps you're aware of and the better questions you ask about the patient. Huh, of the last 10 patients I saw, this is the one patient whose blood pressure was not lowered by this medication.

8:18 Hmm, what is different about this patient? And then you start to ask questions, like to what extent is this patient different in terms of perhaps body mass index or dietary exposure, different things. So you get to ask better questions in your work as a clinician researcher. Number two thing is that it trains you to pay close attention. It trains you to pay close attention. So you are always making observations, whether you're a researcher or not, you're always making observations. But the more you spend time honing and refining and answering research questions, the more you pay attention when patients come your way that don't fit the norm.

9:09 And so in general in medicine, there's always the patient who didn't read the textbook. We joke about that. But the patient who doesn't read the textbook, it brings you so much more information than the patients who do read the textbook, who do present as you expect, as the textbook would suggest that they would show up. And when they present in a way that's different, then it's an opportunity to ask what is different about this patient. And so you pay closer attention to anybody who passes through and doesn't fit the norm. And it trains you to pay attention more to the nuances about the patient that might be different.

9:50 And one of the gifts of being a clinician researcher is that really you do have the opportunity for what people call the bench to bedside translation. Now it sounds actually more glamorous than it really is. But what it really does do is allow you to think about how do I answer questions that might help me help a patient like this, this patient who is unusual, who was outside of the norm? How might I structure my research questions to answer and to help this patient or help a patient like this 10 years down the road? And so you're always paying close attention to opportunities that come from your patient population to really enhance your research program.

10:37 So doing research makes you a better clinician because you pay attention in a different kind of way. Number three is that you tend to find diagnoses that no one else can. And that happens because your patient becomes your teacher. Now in medicine we recognize, we recognize that there is so much that's unknown. We recognize that there's so much more that healthcare could be. There's so much more that we could do for our patients. But we don't always have time as clinicians to really do more, be more, we're just so busy. We're so busy.

11:20 But when you are a researcher, number one, you create space for your research. And over time the space for your research can grow. But what you also do is you create space for thinking. And I would argue that the highest value of a clinician is not what they can do, but how they think. What you do can be put into protocols and you can hire people that will do that. And if that's all they do, if that's all they did for a 10-year period, they get really good at doing. But your power, one of your superpowers as a clinician is your ability to think. And so when you create space for thinking, as you need to, as you're growing a research program, what you also create space for is thinking more critically about the patient that shows up before you.

12:11 Ideally, you're not so swamped with clinical care that you can't even think about the last patient you saw, let alone going back three patients earlier to ask, why is this patient different from the others? And so because you have an inquiring mindset, because you're asking better questions, because you're paying closer attention, you tend to find diagnoses that no one else can. And that's why people travel all over the world to meet the one expert in the one field, because it's a thing you study. It's a thing you understand. And you can find things that no one else can. And so you tend to prioritize the patient as your learning laboratory.

12:55 And so the patient is your teacher. Number four reason why doing research makes you a better clinician. And when I say better clinician, I'm not saying that it makes you better than clinicians. Being a researcher doesn't make you better than somebody else. What it does is it makes you better in yourself. So you're a clinician. It enhances your ability to be a clinician. I know there's this narrative of comparing. And many times in academic institutions, there's sometimes a sense that, oh, the researchers are more valued. Or sometimes it's like, oh, the clinicians are more valued. And that argument will always go on for generations, I'm sure.

13:37 But when I'm asking you to think about it, I'm asking you to think about how can you be better tomorrow than you are today? Not how can you be better than the other person? Because that's kind of like just a false comparison. Because if you feel like you're better than the other person, well, there's always someone who in that metric is better than you. And so you're either sometimes feeling inferior or sometimes feeling superior. And none of them is good for you. But how can you be better? How are you enhancing yourself? That's what I'm talking about. So number four is you make discoveries that apply to thousands of patients. And so you can help the patient in front of you. Or you can help thousands of patients that you may never see.

14:19 And that's a beauty of creating a body of work that other people can use and that patients beyond you will be able to have access to through their health care providers. What's so beautiful is that you may never see another patient again. But any work that you have done, that you have put out in the public space, you've communicated in some way, hopefully through manuscripts and also through presentations, you are able to really impact the care of people that you may never know. And that's so awesome because I think we come into medicine for impact.

15:02 We want to know that the work we do matters. We want to know that the work we do will impact someone else. And so it's such an opportunity for us to be able to do that. And so you want to make sure that you enhance your skills as a researcher because you're really going to be able to make so much impact. And that is important. Number five is that after you're gone, your work is going to continue to live on after you and care for more patients. So you're going to be able to care for patients beyond the grave. And I think it's super important because we really are about impact.

15:44 We really are about making a difference. And if we can make a difference for so many more patients, if our work is going to live on to continue to make a difference for patients, how awesome is that? How awesome is that? And so yeah, these are the things we do need to think about as we're really thinking about big picture. You love to care for patients. You're in medicine because you love to care for patients. And patient care will always be kind of the foundation of all we do. But then the question is, how can you care for your patients better? And research allows you to do that. But also, how can you care for more patients? How can you really expand knowledge?

16:26 How can you contribute to knowledge in such a way that so many more people beyond you will be able to benefit? And I think that's what being a clinician researcher does for you. Now one of the challenges, going back to the beginning, is that research takes time to learn and being able to lead a research program is not something you just jump into when you have finished all your clinical training. You really do need to make that investment. And it is worth making that investment while keeping the clinical care that you do minimal so that you can really enhance the part of you that's a researcher. And people get worried. They're like, I'm going to lose my clinical skills.

17:08 You never lose your clinical skills. What you do need to do is keep up with the literature. And actually, maybe some people will say, well, I'm a surgeon. I'm a proceduralist. If I don't do this often enough, I deteriorate in my skills. And I would give you that. The question is, which part of you do you really want to develop? And what does it take to develop that part of you? If you want to lead a research program, what does it take to do that? And it may be that you don't lead a research program. It may be that you're a partner to somebody else who leads a research program. And that's OK. But it is important to clarify what you want to do in the space of being a clinician and in the space of being a researcher and recognize that honestly, both are two different jobs.

17:56 Both are two full-time jobs. And if you're going to do it well, then you are going to prioritize getting training and research as you have prioritized getting training in clinical care. And these are the things that we do really as we negotiate our lives in the academy. So if you are interested in coaching and really navigating this tricky dichotomies that exist, I would invite you to sign up for one of our coaching programs, reach out to us on our website, clinicianresearcherpodcast.com for more information. We're enrolling the next cohort of faculty in the Academic Negotiation Academy. And these are the things that we help coach around.

18:37 How do you navigate your career as a clinician and as a scientist, as a researcher? How do you do it in a way that feels true to you? Because each of us as faculty members have a different journey. There is not a one size fits all. And if that be the case, then you want to make sure that you really have career satisfaction by making decisions that align with your values. So I invite you to check out our website and sign up for more information. All right. It's been a pleasure talking with you today. If this episode has been helpful to you, please share it with someone else. Don't keep the information to yourself. I'll see you on the next episode.

19:26 Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do health care.