Epidemiology through the eyes of clinicians

consciously or subconsciously.1 Though this is well known, teaching and practice continue to be based on case studies, partially endorsed or unendorsed reviews, and anecdotes. Clinicians fail to appraise the evidence critically because of a poor understanding of research methodology. Therapies backed by ample evidence are underused because of a lack of knowledge or because clinicians believe that results observed in clinical trials cannot be translated into clinical practice.2 Not surprisingly, only 15% of medical interventions are based on solid scientific evidence.1 Clinical medicine appears to consist of a few things we know, a few things we think we know (but probably don’t), and lots of things we don’t know at all.3 In India, epidemiology is well established and mandatory in undergraduate medical training as part of Social and Preventive Medicine. Evidence-based medicine is a fashionable topic known to medical personnel with international exposure but it is yet to be routinely practised. Between November 2001 and January 2002, we performed a survey in three teaching and three nonteaching hospitals in New Delhi to elicit perceptions about epidemiology and its uses from 190 clinicians. We used a questionnaire consisting of 13 items, divided into five broad groups: (1) perception of epidemiology, (2) enthusiasm for taking up epidemiology as a career, (3) status of epidemiology, (4) attitude to epidemiology, and (5) need for training. Each respondent was asked to answer each item with his/her degree of agreement on a four-point scale—strongly agree, tend to agree, no opinion, and disagree. Public health professionals and clinicians already exposed to epidemiological training were excluded from the survey. Of 190 selected clinicians, 151 (79.5%) responded: 32 internists (21.2%), 27 ophthalmologists (17.9%), 26 gynaecologists (17.2%), 10 gastroenterologists (6.6 %), and 24 from other specialties (15.9%); 18 were non-specialists (11.9%), and no specialty was reported by 14 (9.3%). Results of the survey are presented in the Table. A surprisingly high proportion of the clinicians in this survey agreed that epidemiology is a basic science for clinical medicine and therefore necessary for a good clinician (86.1%). The enthusiasm for taking up epidemiology as a career was considerable (41.6%), in particular if better research and job opportunities were provided and a modified, integrated curriculum was introduced (60.9%). While 136 respondents (90.1%) concurred that sound knowledge of epidemiology was necessary for a good clinician, about a third felt that a trained epidemiologist lacked clinical knowledge and was a waste of time for clinicians. A high proportion of respondents felt that epidemiology was a postgraduate subject choice for graduates of lower rank (62.9%). When comparing internists and allied subspecialties (n = 54) with other respondents (anaesthesia, dermatology, gynaecology, ophthalmology, orthopaedics, psychiatry, radiotherapy, and surgery; n = 65), we found internists suggested more frequently that lower ranking graduates took up epidemiology as a postgraduate subject (77.4% versus 57.8%, difference 19.6%, 95% CI: 3.0%, 36.1%), considered epidemiology more frequently to LETTERS TO THE EDITOR 1113