Further thoughts on doctoring


Category : General, Medical Rants

Thanks for all the thoughtful comments.

Let me clarify the organic chemistry point. I do not think that organic chemistry (as taught in college) helps one become an excellent physician. It may help one take biochemistry – but again that course generally has too much depth to make it necessary.

One of our problems is that the world has changed since the Flexner Report first appeared. The first two years of medical school have morphed into a challenging, oft times tangentially relevant, exercise in basic science. Our students are asked to learn basic science at much greater depth than is necessary to practice excellent medicine.

Some would argue that we must understand the basic sciences to really understand medicine. I do not disagree. I postulate that our current programs cover so much material, that few students understand their subjects. We certainly do not test for understanding. We give multiple choice tests which emphasize recall.

When students reach the wards, we teach the relevant physiology or pharmacology, and they invariable question why they were not taught appropriately during their first two years. Until the 3rd year, we emphasize memorizing massive amounts of material.

Often when we ask a new 3rd year student an open ended question they stare in amazement. We have set high hurdles which do not (in my opinion) help students learn how to think through medical situations.

These hurdles do effect how our students think and view the world. They chase away many potentially excellent physicians from even considering medical school

I often quote Stephen Covey’s 2nd Habit – “Begin with the end in mind”. In 2005 we need a fresh redesign of medical school curricula. We should base our curricula on creating the excellent caring physicians that patients deserve.

Perhaps if we fix the curricula, we will be able to attract the right students.

More on this subject in the coming days.

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Comments (9)

I agree that Organic & Biochem were really not that helpful in med school. Physiology, Anatomy, & Pathology we’re probably the most important. But I’m also a primary care doc. If you’re a research type, I could see those Bio & Organic chem being more helpful. I think the med schools could also select a little more for students with a broader range of experiences. I was a philosophy major and I think that helped me just as much in medical school as my science classes. Many of my partners also were non-science majors (psychology, sociology), but then again we’re primary care docs. Maybe we would have more going into primary care if we had more liberal arts grads in med school.

I do think potential medical students give some consideration to the curricula content of medical school,

but I am sure they give much more consideration to
the costs whichAVERAGE about 30,000/year for just tuition. Most students know that there is no partitime med student status and therefore housing/food/text books/ and all other living expenses must be borrowed.

Most college students think very hard on the debt issue and understand that debts easily exceed 160,000 dollars a and hopes to begin paying off the debt will start 4 years after med school and probably last 10-15 years.

“Perhaps if we fix the curricula, we will be able to attract the right students” I suspect that curricula
issues are trumped by cost issues.

I really agree, Dr. Centor. I think I learned basic pathophysiology and pharmacology in year two, but way too much time was spent on in-depth knowledge of which DNA polymerase does what. I think we lose a lot of people who would go into medicine because they’re good at pattern recognition, and would love to work with people, but see the pre-med curriculum as a hurdle they’re not willing to undergo.

Sumer’s Radiology Site
Well I have always believed that the medical school curriculum should be made more apt for a general physician and then let him specialize later on and thereby reducing probably a year of time in his undergraduation. Nowadays at least in India specialization is a must. Sometimes I wonder as a practising radiologist now… Why did I study Biochemistry, DNA Polymerases, etc in my med school……

Dr. Bob,

All I can say about your opinions of Organic Chemistry is that you may have been taught what my fellow Chemists call “Baby Organic” which emphasized biochem-related topics of sugar structure, and memorization of functional groups. The Organic Chemistry courses that our chemistry majors had to take for their degree was based on synthesis and identification. We had to learn reactions in specific and in classes. We had to learn how to identify things based on various types of spectroscopy. We also had a very high quality professor. Lacking those, I probably would not have connected so much with it.

But, I’m also not a doc, yet. My applications are in, though.

I’m a first-year at an osteopathic medical school. I actually feel that we have had pretty good clinical correlations so far, even in our initial Cell Science (essentially Biochemistry) course. We also have an excellent ethics course that requires us to consider a good deal of ethical reasoning and cultural sensitivity. I don’t think there is a way to fully prepare anyone to be a doctor through just four years of premedical education, two years of preclinical, and two years of rotations. Probably the largest part of this preparation is what each of us invest into it, but I feel that it will take a lifetime to develop all the skills I need to be a great physician.

Chemistry IS necessary for doctors. Think of how one figures out what interacts with what. Those would be chemical reactions, would they not? What about in understanding the brain- the brain is a virtual chemical soup/stew, that chemists are FINALLY being able to address. Learning the humanities is not necessarily a bad thing, but it still may not predispose a doctor to LISTEN TO THE PATIENT when they say that X and Y together make them feel funny/worse/icky.

That said, learning chemistry may not help either. But I do think that doctors should know how the body works, so that I as a patient don’t have to figure it out myself on the internet.

Part of the problem with medicine, as I see it, is that there is too much division. A rheumatologist only deals with arthritis like diseases, an oncologist, cancer, a cardiologist, hearts….ad infinitum (and naseum). Some things like inflammation cross over, but no-one sits down and figures it out, unless they are chemists, biochemists, and other science geeks. When the connections ARE made, it takes YEARS to make things mainstream. Think H. Pylori and gastro problems, and the same bug in heart attacks.(2002, Circulation? I think). Funny thing is I don’t see much mention of this in the heart attack do’s and don’ts. They mention noise, pollution, smoking, food, but not bugs.

I realize that most people really don’t care about mechanisms of chemistry or biology when they are sick, but there really are some people who do have a brain and want to know what they are up against and what the options are. They need more than four minutes with a surgeon who is cutting off their breasts. They would like to know why things work and don’t work. When they are about to be under anesthetic for a gynecological procedre, they want to know what it entails, and what the risks are.

I know of two doctors who have been sued. I have been to both. The reason they lost their cases was because they did not spend time telling the patient the risks of a procedure, or they dismissed symptoms as a “woman’s problem”. One lady stroked out and one died of cancer. Both women won their battle, but lost their wars.

Philosophy or chemistry can’t change those doctors. Only patients can, by standing up to these people and showing them their own humanity.

Dear DB

I think this is from Nov 25, and the article on the Parkinsons drug causing a gambling disorder. I quote YOU on the importance of chemistry————-

As my career progresses, I become more convinced that we really do not understand neurochemistry. Phenomena like this one may help us navigate through those waters.

Just thought I would throw that in as another point on why Chemistry and Doctors need each other. It is very frustrating as a patient to tell a doctor that something is happening and have them disbelieve you, because THEY don’t understand neurochemistry either.

I think doctors are like teachers- they pick and choose what they will remember and use in their respective fields based on being human- what they like and dislike and have an affinity for. There are brilliant chemists, and brilliant people persons, and everyone else is somewhere in the middle.

We certainly need to understand some chemistry. However, practicing physicians do not use chemistry. Rather, researchers use chemistry.

Teaching a surgeon, an internist or a family doc chemistry in the depth that our courses provide does not influence how they practice.

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