"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow
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Workouts by month - Goal 200 from 11/1/09 through 10/31/10
The ACP Advocate Blog by Bob Doherty: "There once was a man named O'Bama ..." http://ow.ly/1nUH3 - HCR limericks and a cold one for BobMarch 18, 2010 5:24
http://ow.ly/1mYi7 - ABIM MOC program - two differing viewpoints - you can guess my voteMarch 16, 2010 5:06
RT @yejnes: My thoughts on the annual exam, etc., final letter ACP Internist, March 2010 http://bit.ly/9FNcXn wel-stated & importantMarch 15, 2010 12:47
A note to the professors, from the "real" world, on the use of ICDs in a fee for service community... http://ow.ly/1jaPy - great postMarch 13, 2010 2:19
RT @paulinechen: New "Doctor and Patient"; Learning to Keep Patients Safe in a Culture of Fear http://nyti.ms/bYA14V - blog post comingMarch 12, 2010 1:35
RT @tom_peters: @kevinmd Spoken like an MD. - true primary care is very complex - it is not simple care -March 11, 2010 12:43
RT @efalchuk: Seriously, what is Nancy Pelosi Talking About? http://bit.ly/9sHSc2 #healthreform #hcr #healthcare think Dazed and ConfusedMarch 10, 2010 7:53
Obama Says Health Overhaul Should Trump Politics - http://nyti.ms/bwKRyo - and he is correctMarch 8, 2010 7:28
As the academic starts, I have the opportunity to work with new 3rd year students. I love 3rd year students. They are so excited to escape the virtual prison of the first two years.
They have generally not learned how to think, but are excited that we actually ask them how to think.
As I have oriented students, I remind them that patient volume is the key factor to becoming a better physician. The more patients you see; the more patient problems you research; the more patient case discussions you participate in; the better you become as a physician.
Even celebrating 30 years since I finished my residency, I believe that I continue to become a better internist. Seeing and discussing patients always provides insights and texture that I had not previously considered. Examining patients and interviewing patients improves with practice and experience.
I have heard of unpublished data that suggest that shelf exam scores are best correlated with patient volume. I believe this report to be true.
I worry about work hour requirements and what that means for patient volume, and therefore education.
When I was a resident, I always hoped for a quiet day (because they were so rare) and a busy month. When I had a busy month, I learned a ton. One can not learn medicine from only the lectures and textbooks. You need to see lots of patients too. Third year medical school was the most fun I had in my entire training. I wish I had kept a diary of all the great patients and cases I saw.
In an earlier century, I left New York for a residency without work hour limitations in order to become the best clinician possible. I admitted and managed far more patients than my residents do today (personal record: admitting 23 kids to the Oncology unit in one night). The experience taught me many practical lessons about medicine, interpersonal communication and healthcare systems. However my clinical skills were often based on instinct and tradition instead of grounded knowledge or evidence.
After residency, I sat down to systematically study for the Boards and also took some time to reflect upon my training experiences. The process noticably improved my diagnostic and theraputic acumen. It also gave me a wealth of self-knowledge.
I would support Bob’s view that the more patients we see, the more opportunities we have to learn. But I also encourage students to also take time to reflect on their clinical experiences and to think about their patients’ conditions in a systematic manner. Since every patient is unique, the patients they see on the wards today will only partially resemble the patients they see tomorrow. Taking time to place their patients in context will help them recognize when the next patient has a different diagnosis or requires different care.
3 Responses to On learning medicine – the value of volume
The Happy Hospitalist
July 1st, 2008 at 6:14 pm
100% true
kevinh76
July 2nd, 2008 at 12:27 pm
When I was a resident, I always hoped for a quiet day (because they were so rare) and a busy month. When I had a busy month, I learned a ton. One can not learn medicine from only the lectures and textbooks. You need to see lots of patients too. Third year medical school was the most fun I had in my entire training. I wish I had kept a diary of all the great patients and cases I saw.
rtb
July 2nd, 2008 at 4:48 pm
In an earlier century, I left New York for a residency without work hour limitations in order to become the best clinician possible. I admitted and managed far more patients than my residents do today (personal record: admitting 23 kids to the Oncology unit in one night). The experience taught me many practical lessons about medicine, interpersonal communication and healthcare systems. However my clinical skills were often based on instinct and tradition instead of grounded knowledge or evidence.
After residency, I sat down to systematically study for the Boards and also took some time to reflect upon my training experiences. The process noticably improved my diagnostic and theraputic acumen. It also gave me a wealth of self-knowledge.
I would support Bob’s view that the more patients we see, the more opportunities we have to learn. But I also encourage students to also take time to reflect on their clinical experiences and to think about their patients’ conditions in a systematic manner. Since every patient is unique, the patients they see on the wards today will only partially resemble the patients they see tomorrow. Taking time to place their patients in context will help them recognize when the next patient has a different diagnosis or requires different care.