Saturday, October 10, 2009

Is our method of training medical students flawed?

The majority of people who go to medical school have an idealistic idea of saving lives and helping sick people get well. Yet patients complain that doctors seem to lack caring, compassion and dedication to the profession. Is something missing from the training of a doctor that prevents them from having the characteristics patients expect? Is it the process of medical training itself that causes this? Or is it that we are simply selecting for medical school the kind of person who will be successful yet incapable of having the kind of attributes that patients want?

I am working on a book that removes the shroud of mystery that surrounds this transformative process. I can and have recounted scores of stories about my medical school training that sound ridiculous and unbelievable, but sadly were true experiences. I would like you to help me in two ways:
  1. If you are not an MD, I would like to know what is in your head when you picture what is involved in the training of a physician.

  2. If you are an MD or medical student, I would like to know what is the most cut-throat, horrible experience you've had in pre-med, medical school and/or residency training.

Please write your answer in the comments section. By writing you give consent that your comment could end up somewhere in my book. Whether you use a real name or not, if I use part of your comment, I will give you credit in my acknowledgements. And if I use any part of one of your comments, and you leave an email contact, I will send you a free book when it is published.

Thanks for your help!


  1. Attending surgeon loses dog. Calls residents Saturday am to come to farm to hunt for said dog. After several hours they find dog. Surgeon shoots the dog and kills it in front of the residents. The surgeon says: "That's how I treat deserters. That's your lesson for the day."

    One of my attending surgeons was one of those surgery residents (in the 50's or 60's it must have been). Story confirmed by several other attending surgeons. Interesting, everyone of those surgeons who hunted for the dog that day was a super nice, awesome guy.

    Maybe sometimes you learn what not to do :)

    Dr. Jen Gunter (Yup fron twitter)

  2. I am a 2nd year D.O. student, who previously volunteered and worked as an EMT for six years prior to medical school. I feel like I can empathize with both sides, and its surely a very complex issue. As a patient its hard to imagine the reality of the demands and considerations of medical practice based on how they are unlike the examples the public sees and references on shows like, "House M.D." or "Dr. 90210", (these are dramas, and exceptions). At the same time it is increasingly harder for a medical practitioner to come to an agreed diagnosis and treatment strategy due to the ease of access to information where patients now convince themselves of a diagnosis ( which coincidentally is often the rare 'zebra', and is based on poor sources such as wikipedia). The reality of medical school is that there is much more emphasis on compassion, and addressing patient concerns, possibly relevant cultural differences than I ever would have thought. However the large volume of information we are expected to master, and the situations we are expected to deal with is daunting and can easily take a toll on our physical and mental health. When this is combined with patients who often have beyond what would be a healthy skepticism of our medical prowess based on the difference in our levels of education "frustration" often does not begin to cover the feeling. (It appears to be increasingly common for me to see patients arguing with my preceptors and attempting to dictate their diagnostic workup and course of treatment, note to patients I respect your opinion but please don't do this.)In summation its not necessarily the selection process, if anything the process is now oriented for getting the desired traits of people, versus the traditional type A dominant egotistical genius that was the stereotype. The solution involves redefining the role between practitioner and patient, we need to actively ellicit, discuss, and alleviate patient concerns; build confidence and rapport, and educate patients with good science. Never underestimate the importance of 'people skills'. -Dane Gruenebaum, OMS II,

  3. One attending we had said there were 3 rules:
    1. Never admit a woman who wears gold shoes
    2. Never admit a woman for chest pain because women don't get heart disease
    3. Never admit those with HIV, no reason, just don't do it.

    If you violated the rules of this powerful man, there was truly hell to pay for you, physically, emotionally and with career. I saw true bravery on the part of fellow residents who made things happen for their patients in light of these rules.

    He hated gays, hated women and just for kicks requested that a gay guy and I do a month with him for sport before we finished residency. For the month, he mainly screamed at me, non-stop in front of my residents and students. Worse, to the gay guy, he simply ignored his existence. At the end of the month, I survived, my fellow resident did not. He committed suicide the day we finished. This doctor found me that morning so he and a buddy (another famous doctor you would all know) could share a gay joke with me and see the look on my face. I did not think it was funny. What do you say to that? I just turned and focused on my patients at hand.

    Now, I feel very sorry for this doctor who has wanted to be important all his life and acted this way. He has to know, on some level and that is why I feel sorry for him.

    I could tell you a LOT more stories, but it would just scare you.

  4. anonymous, thx for sharing. If it is scary that is the point. people need to see this stuff. Please share more. That is why i am writing a book on this...The only way to change things is to remove the obfuscation. Don't keep these stories hidden and in the shadows.

  5. I was part way through my third year Internal Medicine rotation. I found myself sleeping all the time, with no energy, and no interest in life. Having had some trouble with my mood in the past, and having just completed my psychiatry rotation, I was concerned that I might be struggling with depression, so I went to my immediate superior, the resident on my team. I explained my concerns and asked for his advice. His reply, as I remember it: All medical students feel that way during their clerkship (especially Internal Medicine), especially the female half. (And by the tone of his voice I got "quit whining and suck it up.") By the end of the rotation, having done nothing about this problem, I was suicidal. Thankfully, my chief resident was much more understanding and, with family and friends, supported me until I got back on my feet.

    Dr C. Tisher

  6. Dr. Tisher: Thanks for sharing. Many residency programs don't wise up until students start jumping off rooftops.Often it is not the workload, but the stress of expectations we put onto ourselves that causes these depression symptoms. I'm glad you had someone understanding who could help.

  7. Writing a book for public consumption about controversial physician behavior...doesn't sound consistant with the following:

    I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:
    To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

    I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

    I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

    But I will preserve the purity of my life and my arts.

    I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

    In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.

    All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

    If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.

  8. anonymous(#2): I am familiar with the Hippocratic oath. And.......what is your point? Nothing in that oath about how you train a doctor. I want to bring to light how doctors become doctors-currently a nebulous process, because if you don't understand the problem, there can be no solution. If there can be improvements in the training of a physician, that is ultimately good for everyone.

  9. My point is, is medicine an art, delivered by 'priests'? or a science, delivered by technicians? If it is an art, perhaps it can, and should, remain 'nebulous'.
    If it is a science, God help us all. (Mengele, psychiatrists in the USSR, etc). That oath, and the imperfect process of training physicians handed down over time, is a shield against evil. You do think evil exists, don't you?

  10. Anonymous-I really don't think you understand what medicine is all about at all. Are you really suggesting that physicians are all to be compared to Mengele if they do experiements? Have you not heard of the IRB? If an experiment in US is showing any evidence of harm, it is shut down midway. And to answer your question, medicine is both. An art and a science. It is fairly easy to teach the science. But the process of training a physician overall is full of obfuscation and should be brought to light in order to make improvements. And what many don't realize is that the process begins before schooling begins. It begins in the selection process. In college. It begins with one single question: Who do we want to be our future doctors? And while patients are demanding a change, the schools are selecting the same kind of competitive competent student that they always have-who will do well in med school, but don't have the kind of "touchy-feely" aspects that patients desire. And calling something an "art" does not imply we are priest-like by any means. It simply means it comes from a different part of the brain and requires a different kind of training e.g. apprenticeship

  11. We come to same point from different directions. Wisdom. How to develop it, encourage it, nurture it? Certainly the practice of medicine fosters it. But who crosses the threshold to begin to practice? The overemphasis on science has consequences, and we see those consequences today. Putting together a bunch of people with narrow focuses does not equal a general one.
    I think it is interesting how the advent of so called 'information technology' has hastened the decline. We now find ourselves with lots of data, but no one interpreting it well. In the cacaphony of voices out there, the loud are being heard above the wise. What if it is as good as it could be?

  12. i've heard of preclinical students disfiguring other students' cadavers in anatomy lab to make it harder for them to learn the material and with the hopes of catapulting themselves to a higher class rank. is a blog by someone who hated their medical education and went on to do nonclinical work. it has a lot of anecdotes, might be worth checking out.