Sunday, November 9, 2008

(Pre)Medicine. Part I.

I've started to read Pauline Chen's columns in the NYTimes. There are two columns that I want to bring up together, Stories in the Service of Making a Better Doctor and The Misery of the Med Student. Both of them ask basically the same questions. What makes a good doctor? How do we train medical students to be good doctors? The consensus is that well-rounded individuals make good doctors. We want doctors who can related to their patients, who can talk to them well, who care about them as a person and not as a disease, etc.

But I'm not sure how to judge medical schools' efforts at making well-rounded doctors. Are they really successful? Or are they just making some insincere effort at making it seem like medical schools care about more than the science of human body function?

Chen writes positively about the addition of narrative medicine in medical school and residency curricula. These are classes in which students read fiction and non-fiction works to gain better insight into a patient's Her column has anecdotal evidence for it and she says that studies have shown that it is successful. But it is also true that most doctors don't love literature, the arts, or the social sciences as much as people with advanced degrees in those fields. Otherwise they wouldn't be doctors. I think narrative medicine classes valuable if they can be taught so that even med students who don't like literature can discuss it in a meaningful way that helps them as doctors. Otherwise, as one comment said, it's just a glorified book club.

Med schools now require a certain number of humanities credits so they can accept more well-rounded applicants. But how do you know who took humanities classes as a undergrad because they really liked them or because they needed it to apply to med school?

Or do you even think this distinction matters? It is really hard to study anything other than medicine when you're in medical school because there's so much medicine to learn. Everything else has to get put on the backburner. One comment talks about the difficulty in fitting in other interests in med school:
I am a medical student with a literature background from undergrad. I wholeheartedly agree with the purpose of these programs, but the reality is this: the things one must learn in the med school — anatomy, physiology, pathology, immunology, microbiology, etc. — are simply too time-consuming to allow more than a cursory study of literature in some kind of throwaway class. Those students who are interested in it will explore further, but the vast majority won’t find it useless and will just resent it.

Dr. Chen had a similar experience in medical school. There was just so much to learn that these other efforts didn't diminish the amount of sheer information they had to learn. She writes:
Some of my professors tried to 'humanize' the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?

Is waiting to go to medical school after earning some "life experience" the remedy to the lack of empathy, humanities, and high burnout? Several of the comments were from people who had a career before entered medical school and they seemed happy with their decision. I think this is generally a good idea, but it doesn't address whether or not medical education as it is should be changed. It simply gives med students time to steel themselves before plunging in.

I don't know the answer to these questions. In an ideal world, we would all be Renaissance men and women. Our journals will contain anatomic diagrams alongside sketches of landscapes, the Madonna, and fantastic flying machines. We'll spend our days in the chemistry lab and write music by night. We'll all be well-read, empathetic, intuitive, doctors.

But in reality, our time is finite. We have to make choices, prioritize, and prepare for standardized exams. And I have physiology lectures to watch. Oh, and I could be totally wrong about everything because I haven't actually gone to med school.

That's all for tonight. The next post about this matter is going to get a lot more personal. I reflect on how I have taken to trying to be a well-rounded (future) physician.


Jessieroo said...

Lots to think about...

I love your thoughts though. I have thought all the same things about medical school. It's nice to know I wasn't just crazy for questioning the system that so many people would kill to get into.

Marci said...

although you know i'm not even contemplating med school, i've met a lot of premed/med/public health students here. Obviously just by being here they are fulfilling that "life experience," while still relating it to medicine. Some are working in labs, others are going into the field and doing research like I am, others are working in clinics. I'm not saying one is more valuable than the other, because just by being here you are learning something about humanity and society. I too feel limited by whatever field I choose, but not to the extent of med school there are a lot of successful people who made it through med school and are able to relate medicine to society in an effective and meaningful way.

PS I was planning on responding to your last email but can you resend it to my new address or MSU address? thx!

RaisinBagel said...

I hope that you write a new post soon. I am looking forward to reading more about your plans/goals/dreams.