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Cutting the vagus nerve: Clinical practice and research in medicine

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Canadian Family PhysicianLe Médecin de famille canadien Vol 54:  may • mai 2008

Cutting the vagus nerve

Clinical practice and research in medicine

Savithiri Ratnapalan

MB BS MEd

S

omebody  has  to  take  care  of  the  patients.”  This  statement  is  often  mentioned  by  busy  clinicians  whose time constraints prevent them from embark- ing on research or other scholarly activities. This article is  a reflection of what could happen if we stopped searching  for new answers. 

Common belief

I am a clinician-teacher in a tertiary care pediatric emer- gency  department,  and  I  work  3  to  4  shifts  weekly.  As  expected,  the  emergency  department  shifts  are  busy,  noisy,  and  very  tiring.  At  the  end  of  each  shift,  I  know  that I have worked hard, taken good care of my patients,  and,  I  hope,  helped  them  get  well.  Many  clinicians  believe  that  clinical  care  is  the  main  way  physicians  effect  change  in  patients’  lives.  Clinicians  in  academic  environments  often  say,  “All  this  research  activity  is  good, but somebody has to take care of the patients.”

Eye-opener

I  recently  began  to  teach  a  graduate  course  called  Continuing Education in the Health Professions. One day  the topic was educational research. I tried to stress the  importance  of  conducting  and  publishing  research  to  my class of clinicians, most of whom were family physi- cians. The conclusion of our discussion about the barri- ers to doing research and writing papers boiled down to 

“somebody has to take care of the patients.” I could not  argue with that idea. 

I  did,  however,  explain  why  I  think  research  is  important—what  I  say  to  myself  when  I’m  tempted  to 

compare the number of clinical hours I work with those  of a researcher. I said to my class, “Well, we would still  be  working  hard  prescribing  antacids  and  cutting  the  vagus  nerve  for  peptic  ulcers,  if  we  did  not  have  medi- cal research. Doctors worked very hard to provide what  they considered the best care at that time.”

I think that statement got their attention. I hope some  of  them  will  question  the  status  quo  and  look  beyond  providing immediate patient care. 

Dr Ratnapalan is an Assistant Professor in the

Departments of Paediatrics and Public Health Sciences at the University of Toronto in Ontario, and a staff physician in the Departments of Paediatric Emergency Medicine and Clinical Pharmacology and Toxicology at the Hospital for Sick Children in Toronto.

Competing interests None declared

I

n  the  past,  it  was  believed  that  peptic  ulcers  were  caused by stress and dietary factors. Treatment con- sisted of bed rest, special bland foods, and milk drips. 

Then  antacids  and  medications  that  block  acid  pro- duction became standard therapy. Patients who failed  medical  therapy  were  usually  offered  one  of  several  methods of surgical treatment, which involved remov- ing part of the stomach and cutting the vagus nerve. 

Australian  physicians  Robin  Warren  and  Barry  Marshall identified the link between Helicobacter pylori  and peptic ulcers in 1982. It took more than a decade  for the medical community to accept their finding.

Reflections

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