Professor David Scott
Professor David Scott is professor of clinical rheumatology at King’s College Hospital in Denmark Hill, South London, and holder of an Arthritis Research UK programme grant.
What does your work involve?
I'm a clinical academic; a consultant rheumatologist who also undertakes research and teaching. My clinical activities drive my work and my research flows from my clinical practice. I undertake two types of clinical activity. Firstly, I provide opinions on new referrals – identifying what's wrong and what should be done. Secondly, I'm engaged in the long-term care of people with inflammatory arthritis. From my perspective – a rheumatologist interested in the care of inflammatory arthritis – the crucial questions are what's good care and how can current care be improved? The issues that interest me are quite separate from finding new treatments. I prefer to concentrate on practical questions about how to make the most of what's currently available.
The research itself can be divided into three types: observational studies, clinical trials and analyses of existing publications. Clinical trials are essentially a way to sort out if one treatment is better than another. Analyses of existing publications – which are usually systematic reviews – involve evaluating all the work published on one form of treatment or another and combining the results in a systematic way, and observational studies involve trying to answer questions. One current question is whether ethnicity affects our assessment of arthritis. A second current question is the relationship between pain, fatigue and activity in arthritis.
How long has Arthritis Research UK been funding you?
I started in academic rheumatology in 1979, working in a building part-funded by Arthritis Research UK. Since then my research has received ongoing Arthritis Research UK support. Our recent programme on quality care in arthritis has been funded for the last five years.
What’s the most important thing you have found out in the past 12 months? Why?
Clinical research progresses slowly. There are usually no sudden steps forward. Our most important current theme is showing the extent to which intensive early treatment is effective with conventional disease modifying drugs and steroids. Changing specialist practice to adopt early intensive treatment over a policy of 'wait and see' is likely to greatly improve the outcome of most people with arthritis.
What do you hope to achieve as a result of your Arthritis Research UK funding?
Delivering high-quality care is a universal goal but it can't happen by itself. I hope that our research on clinical quality will move forward the way clinical units manage people with arthritis.
What do you do in a typical day?
My weeks follow a pattern rather than my days. Clinical research and service merge together and both activities are dealing with the problem of how best to treat arthritis. My biggest challenge is to keep ahead of the deluge of electronic communications we all face from emails, telephones, electronic patient records and clinical research databases. On top of these activities I fit in teaching medical students, postgraduate students and specialist trainees.
What's your greatest research achievement?
Recently, showing intensive treatments are effective feels more rewarding than establishing the limits of conventional care.
Why did you choose to do this work?
Fate sent me to work with Professor Verna Wright, an inspirational academic rheumatologist, in the mid-1970s. I loved working in his unit and once started in rheumatology I just carried on. The same was true of my research field. I began with laboratory research but by degrees moved to quality and outcomes research because I was drawn to it.
Do you ever think about how your work can help people with arthritis?
All our research focuses on improving patient care. Sometimes individuals may not directly benefit – spending time filling in questionnaires or taking part in trials isn't always an immediate advantage – but without such ongoing research care generally can't improve.
What would you do if you weren’t a clinician/researcher?
I spend my time talking to people and writing in a public sector environment. These are infinitely transferable skills. Regrettably they don't lead to what might be called 'exciting careers'. But I never think what else I might have done – it’s sufficiently challenging dealing with what I'm currently doing.
In some ways the digital age academic medicine is a full-on 24/7 commitment. It seems to take all my days, consume all my evenings and run away with most weekends. I'm not concerned about this – academic medicine is addictive, and like other addicts I enjoy the involvement. I'd love to spend time on other pursuits, but unless the days are lengthened or I abandon sleeping it’s difficult to see how to fit them in. When you've found something you like, it may be best to stop searching for something else.
This article first appeared in Arthritis Today Summer 2009, issue 145.