Hypothesis: Good patient care, research and education should be so inextricably linked that each should drive the other towards improvements in quality of care, innovation and discovery.
Discussion: Each element of good clinical cancer care, including specialisation, multidisciplinary management, audit and systematic organisation, provides a powerful stimulus to research. The qualities required for good research inevitably enhance educational activity. High quality in education and training are essential in improving cancer care. Obstacles to good medical care are identified and the importance of supporting doctors is emphasised. The question of permanent staff-grade medical appointments or the grade of physician assistants is raised. Challenges to university-based and hospital-based research are outlined. Attention is drawn to issues concerning the training of cancer specialists, particularly in surgical oncology.
Conclusion: Good patient care stimulates research, research drives educational activity and education improves care. Interaction of these elements of medicine and science constitutes an interdependent upward spiral towards excellence.