Friday, 9 January 2009
Exclusive interview with Sir Muir Gray, Chief Knowledge Officer for the NHS
'Knowledge is as important as antibiotics' claims Sir Muir Gray, Chief Knowledge Officer for the NHS. He tells us why in an exclusive interview for the UoS Librarians' Blog.
Just before Christmas Vic had the privilege to interview Sir Muir Gray, Chief Knowledge Officer for the NHS. Sir Muir trained initially as a surgeon before working in public health and more recently in R&D. He is a passionate advocate of patient empowerment and has written extensively on this topic. Currently Director of the National Knowledge Service and responsible for the National Library for Health, Sir Muir was knighted for his services to the NHS in 2005.
Vic: Congratulations on your knighthood. Would you like to see a return to the days when all doctors were addressed as Sir?
SM: Even the female ones?! What’s more important is how doctors address patients. The evidence suggests that patients like to be greeted by their clinician and like to be addressed by name. So not dear or love or what do you say in Sheffield?
Vic: Duck or Mi Love!
SM: Well down with 'Ducks' and 'Mi Loves', patients like to be called by name.
Vic: A new edition of Evidence Based Healthcare is to arrive in our bookshops imminently. What’s new for the new edition?
SM: There will be more about public health and also a focus on how evidence based healthcare should be taught. I’ll send you a signed copy for the University of Sheffield Library. (Vic lands a freebie again!)
Vic: Evidence based medicine is sometimes defined as doing the right thing right. How often in healthcare do you think we don’t do the right things right?
SM: I don’t have any figures with me but what too often happens is that we do the wrong thing right, for example I think we do prostate-specific antigen testing well, from the lab's perspective, but it’s not actually effective. Sometimes we do the right thing wrong which is a quality issue. The question is value, we should be asking ‘is this good use of time?’ because time, not money is our most scarce resource.
Vic: Many clinicians still appear to believe that medical librarians do little more than stamp out books. When did you first realise that librarians could make a direct impact on improved patient care?
SM: I have always valued the role of the librarian in supplying knowledge. The job of the clinician is to get knowledge into action. Knowledge is as important as antibiotics and the first thing I do when I undertake a project is to appoint a librarian. Love your librarian!
Vic: Who do you feel is best placed to teach evidence based medicine- a medical librarian or a clinician.
SM: It has to be both because they bring different things. Let me show you (proceeds to draw)
Vic: Despite our best efforts to the contrary, many of our medical students choose Google over Medline. Do you have any comments on this?
SM: I think Google is wonderful because it is so easy to use. What we need to do is ensure that the best evidence is presented so easily, for example we could use the thousands of letters and lab reports sent out by STH each year to provide a simple web link to the best evidence. It is about embedding our resources into everyday life and everyday practice.
Vic: We are currently running a series of blog posts to promote our 10 favourite health information resources. What would be in your top 10?
SM: Well, Google would definitely be there as would the National Library for Health of course and Cochrane but also Knowledge Into Action http://www.knowledgeintoaction.org and also the key one that medical students might be interested in is Climate Connection www.climateconnection.org which is looking at sustainability of health.
Vic: You have famously and controversially been quoted as saying that much of what is published in the medical journal literature is not clinically significant and that instead of subscribing to journals per se, we might simply purchase those articles based on good clinical trials. Do you think this could become a reality?
SM: Yes. Even in the best journals over 30% of controlled trials are invalid and weak. The peer review process is too often ineffective. We need to improve the quality of peer review.
Vic: What role then do individual case reports, consensus and anecdote have in evidence based practice and how should these be shared?
SM: There is a new open access journal, Cases journal (http://www.casesjournal.com/) which aims to publish interesting case reports from any area of healthcare. Knowledge from experience is invaluable. Mistakes, for example, are not well collected at present.
Vic: The Librarians’ Blog for Medicine has the slogan ‘knowledge is power’ but your slogan is ‘knowledge is the enemy of disease.’ Which is right?
SM: Knowledge is power and in the NHS that power is the enemy of disease. It’s about knowing when and how to use knowledge and that’s what makes a difference.