Some doctors have deep contempt for patients

[halcyon]

Perhaps medical schools need to spend more time teaching the human skills necessary for being a decent physician, since theoretically medicine is all about interacting positively with vulnerable people.

This would probably go a long way, but as I have recently learned, the situation is quite the opposite in some cases, and some medical students seem to suffer a great deal of physical and mental trauma during their training.

http://www.medscape.com/viewarticle/557598

 

[SOC]

This would probably go a long way, but as I have recently learned, the situation is quite the opposite in some cases, and some medical students seem to suffer a great deal of physical and mental trauma during their training.

http://www.medscape.com/viewarticle/557598

This cannot be helping them act like decent human beings in the future. Sounds like the professional organizations need to start taking a stand on both student abuse by medical schools and patient abuse by doctors. The whole thing has gotten far too far out of hand.

 

[Butydoc]

This cannot be helping them act like decent human beings in the future. Sounds like the professional organizations need to start taking a stand on both student abuse by medical schools and patient abuse by doctors. The whole thing has gotten far too far out of hand.

Hi SOC,

Medical school is not where students are abused. Medical school is much more like high school and college, sit down classed, clinical rotation and finals. It is the residency where all the abuse happens. When I was resident in general surgery, I worked between 100-120 hour/week. I was on call in the hospital ever other night for 5 years. It wan't unusual to spend 36-48 hour without sleep. I was in a pyramid program where 5 residents started and only 2 finished. Very competitive and stressful. Now laws have passed that a resident can only work 80hour/week and the pyramid programs no longer exist. Most residents are married and have children and are buried in debt which has accrued from college and medical school. Not a great way to start a career.

Best,
Gary

 

[Sean]

While we're at it....

I continue to be astonished at how poor the basic scientific training of doctors seems to be. They claim to be scientific, but they don't seem to understand fundamental concepts -- correlation is not causation, theories are not absolutes, current knowledge is always changing, you need evidence to back up your theories, simple statistics, just because we don't understand something doesn't mean it doesn't exist, rules of thumb are not fundamental principles, and so on, and so on, and so on.

As they say, doctors tend not to make good scientists. Different skill and mind set. Doctors are typically very good at diagnosing and treating things medical science already knows how to diagnose and treat. Not so good when it comes to dealing with poorly recognised and understood problems, of which there are many.

Whatever my rants against the medical system over the way they have treated ME/CFS patients, I still think that modern science based medicine (including dentistry) is easily in the top five achievements of the human race, and that it has alleviated huge amounts of suffering, with the promise of much much more to come.

Also think that modern medicine needs to treat its junior members a lot more sanely and decently. 120 hour weeks, including on call? That was a huge and inexcusable problem 35 years ago, and sadly still is now! It is a serious scandal and danger to all.

 

[free at last]

Without evidence, I mean evidence that can not be disputed.
This is one prejudice, that will always simmer away in many places.
I live for the day, of that hard evidence, that is overwhelming. So doctors, and people. sometimes even family. Finally
know what we all went through.
When we start getting apologies from many different medical professionals. Then we will know its finally over. Untill then, I have become cold to it. It hurts like hell. its just plain wrong on so many levels
Just hope for everyone, myself included we one day get what we deserve. Respect
Right now its only from certain places I am afraid.
You would be surprised how dis belief can be so strong. Even with mounting evidence. I know this story. without ultimate proof, get used to it. Its not going to change until proof takes over, trust me on this ive seen it before

 

[Hip]

My impression is that very, very few physicians have done independent research, even at the master's degree level.

Much of medical science tends to be done by medical researchers, rather than medical clinicians, as far as I am aware.

In some ways I think the difference between medical researchers and medical clinicians is analogous to the difference between physicists and mechanical engineers.

When I was doing my degree in physics, I had some mechanical engineer friends, and what struck me was that while both subjects employed similar mathematical techniques, the mindset of the mechanical engineers was quite different to that of the physicists. The mechanical engineers seemed to want to learn the techniques of their trade in order to go out in the world and apply them, and build things. Whereas the physicists were more driven by curiosity, and the desire to explore the hidden depths of nature.

 

[SOC]

Much of medical science tends to be done by medical researchers, rather than medical clinicians, as far as I am aware.

Of course. That doesn't mean clinicians don't pretend they are scientists while lacking true scientific training. Medical researchers are another kettle of fish.

In some ways I think the difference between medical researchers and medical clinicians is analogous to the difference between physicists and mechanical engineers.

When I was doing my degree in physics, I had some mechanical engineer friends, and what struck me was that while both subjects employed similar mathematical techniques, the mindset of the mechanical engineers was quite different to that of the physicists. The mechanical engineers seemed to want to learn the techniques of their trade in order to go out in the world and apply them, and build things. Whereas the physicists were more driven by curiosity, and the desire to explore the hidden depths of nature.

As a research mechanical engineer, I agree with you on some points, but disagree on others. I would not say the difference between medical researchers and medical clinicians is analogous to physicists to mechanical engineers. Mechanical engineers learn the principles of science. We learn logic. We learn problem-solving from basic principles (not rules of thumb and the like). We learn statistics. We learn to read and understand research papers. We do independent research at both the masters and doctorate level (unlike medical clinicians).

I will agree that mechanical engineers tend to focus on applying the principles of science for the betterment of mankind, rather than focusing only on learning more about the nature of the universe, although there's a lot of blurring of that line -- engineers who do primary research and physicists who do applied work.

I'd say the analogy is more like medical researchers are to biologists as mechanical engineers are to physicists. One group applies the principles for functional use and the other group studies the universe to help understand the basic principles. Both groups use science and problem-solving. Medical clinicians are closer to the high-level technicians in our world. They have some impressive skills, but they are not scientists or problem-solvers. They work from rules of thumb, data tables, and such rather than from basic scientific principles. Without them the system wouldn't function. The researchers are not (routinely) down at ground level with the wrenches making things work on a day-to-day level. The technicians and medical clinicians are. But that doesn't make them scientists.

 

[rosamary]

When we start getting apologies from many different medical professionals.

I am certain that there will be no apologies

 

[Hip]

I will agree that mechanical engineers tend to focus on applying the principles of science for the betterment of mankind, rather than focusing only on learning more about the nature of the universe, although there's a lot of blurring of that line -- engineers who do primary research and physicists who do applied work.

Yes I agree there is a lot of blurring of that line, and even in most individual engineers or physicists, I think you tend to get aspects of both these mindsets in the same person: the engineer's "applying and building" stance, and the physicist's "curiosity and exploring" disposition.

Myself, professionally I used to work in software, which is tapping more into the "applying and building" engineering side, which I do very much enjoy; but secretly my real interests were in exploring things more deeply. Due to undiagnosed attention deficit issues, which always made me slow learner of facts and details, a scientific research career was not quite feasible. That did not stop me exploring various subject areas in my own time though; when curiosity is present, it compels you to explore, even if your intellect cannot quite keep up!

 

[chipmunk1]

Hi SOC,

Medical school is not where students are abused. Medical school is much more like high school and college, sit down classed, clinical rotation and finals. It is the residency where all the abuse happens. When I was resident in general surgery, I worked between 100-120 hour/week. I was on call in the hospital ever other night for 5 years. It wan't unusual to spend 36-48 hour without sleep. I was in a pyramid program where 5 residents started and only 2 finished. Very competitive and stressful. Now laws have passed that a resident can only work 80hour/week and the pyramid programs no longer exist. Most residents are married and have children and are buried in debt which has accrued from college and medical school. Not a great way to start a career.

Best,
Gary

This cannot be helping them act like decent human beings in the future. Sounds like the professional organizations need to start taking a stand on both student abuse by medical schools and patient abuse by doctors. The whole thing has gotten far too far out of hand

Some doctors have deep contempt for patients

So to sum it up: A system of widespread abuse.

 

[lauluce]

There are more doctors who feel this way than would care to admit it but this is a particularly stunning quote. Its Breathtaking the abject stupidity and ignorance this man displays especially now that we ALL (except for this idiot) know how dizzyingly complex human health is, both good health and poor. To settle on the, "these people are just lazy" explanation, my god what century is this guy living in.

that guy should clean doctor's offices not practice medicine in them, that's all his intelligence allows... and that's almost an insult to cleaning personnel

 

[DanME]

While we're at it....

I continue to be astonished at how poor the basic scientific training of doctors seems to be. They claim to be scientific, but they don't seem to understand fundamental concepts -- correlation is not causation, theories are not absolutes, current knowledge is always changing, you need evidence to back up your theories, simple statistics, just because we don't understand something doesn't mean it doesn't exist, rules of thumb are not fundamental principles, and so on, and so on, and so on.

My impression is that very, very few physicians have done independent research, even at the master's degree level. Maybe that's why so few seem to understand research, or have the ability to process the results of research. To get a doctorate in any other field, one has to do research. One has to think for oneself, not just suck in a lot of data and regurgitate it on call.

Medicine is still very much an art. To do it well takes more than just book learning. It's based on science, but it's not science in and of itself. There's still so much we don't know about human biology that practicing doctors have to do a lot of guessing and extrapolating beyond their data. Some do that well, others very badly. It's not their fault that the scientific data isn't there yet. They have to do the best they can with the information they have. My complaint is that they want to pretend they're all scientific, when really they're not. They're more like highly intelligent skilled artisans in a field based on science. Architects aren't scientists, either, but at least they know it.

As a former med student (in Germany) I can tell you, your observations are completely right. Doctors are trained in the art of medicine, not in the art of science (like biologists, physicists, biochemists and so on). You need an immense foundation of factual knowledge and a lot of experience to be a good doctor. But the actual training in scientific thinking is very basic, even often if you do a doctorate (which is optional in Germany). It is indeed comparable to architects, engineers or lawyers.

To be fair some med students are exceptionally interested in science and scientific concepts and work in their free time on interesting research projects, but they are not in the majority. In Germany they try to solve this problem by intruducing a bachelor and master system for med schools. So the students would have to write mandatory bachelors and masters theses about some research projects. I think, this will improve scientific training and this is indeed very much needed for the future.

For emergencies and most standard procedures you don't need to debate the science. It would even be harmful, because it wastes a lot of time, while the patient needs immediate treatment to get better. But in a lot of cases and for a lot of diseases it is immensely important to understand, what's going on inside the research community. It's important to understand statistcs (a lot of my friends e.g. don't understand, why the PSA test for prostrate cancer is not a good test and general screening of the population would lead to more harm than good).

So what's the solution for his problem? I think med schools should lighten up the curriculum a little bit to give free room for advanced scientific training. I learned all the muscles of the body, which I absolutely don't need as a psychiatrist or GP later in my life. Also I had to learn a lot of details about absurdly rare diseases. The main symptoms would have been enough. And so on. I had a lot of interesting courses in statistics and scientific concepts, too. But they all stopped at the basic level. My advanced knowledge came from being involved in research. Which I did voluntarily .

But the most important part would be, that doctors know their limits and realise, that they are not trained scientists, though they know a lot of scientific facts. This must stop! It would improve the whole world of medicine to an incredible degree.

 

[chipmunk1]

In Germany they try to solve this problem by intruducing a bachelor and master system for med schools.

They should introduce a little bit of sanity, common-sense and humility in the system.

I think no one here would have had a problem with doctors if they had just admitted they don't know what the problem is.

For me that would be more than enough. See how little patients expect.

 

[DanME]

They should introduce a little bit of sanity, common-sense and humility in the system.

I think no one here would have had a problem with doctors if they had just admitted they don't know what the problem is.

For me that would be more than enough. See how little patients expect.

Yes. Totally agree.

 

[Sidereal]

@DanME, did you get sick with ME while in medical school? How was it received by the elders?

 

[chipmunk1]

that guy should clean doctor's offices not practice medicine in them, that's all his intelligence allows... and that's almost an insult to cleaning personnel

i doubt that this would work out. The floor does not want to be cleaned !?

 

[Butydoc]

As a former med student (in Germany) I can tell you, your observations are completely right. Doctors are trained in the art of medicine, not in the art of science (like biologists, physicists, biochemists and so on). You need an immense foundation of factual knowledge and a lot of experience to be a good doctor. But the actual training in scientific thinking is very basic, even often if you do a doctorate (which is optional in Germany). It is indeed comparable to architects, engineers or lawyers.

To be fair some med students are exceptionally interested in science and scientific concepts and work in their free time on interesting research projects, but they are not in the majority. In Germany they try to solve this problem by intruducing a bachelor and master system for med schools. So the students would have to write mandatory bachelors and masters theses about some research projects. I think, this will improve scientific training and this is indeed very much needed for the future.

For emergencies and most standard procedures you don't need to debate the science. It would even be harmful, because it wastes a lot of time, while the patient needs immediate treatment to get better. But in a lot of cases and for a lot of diseases it is immensely important to understand, what's going on inside the research community. It's important to understand statistcs (a lot of my friends e.g. don't understand, why the PSA test for prostrate cancer is not a good test and general screening of the population would lead to more harm than good).

So what's the solution for his problem? I think med schools should lighten up the curriculum a little bit to give free room for advanced scientific training. I learned all the muscles of the body, which I absolutely don't need as a psychiatrist or GP later in my life. Also I had to learn a lot of details about absurdly rare diseases. The main symptoms would have been enough. And so on. I had a lot of interesting courses in statistics and scientific concepts, too. But they all stopped at the basic level. My advanced knowledge came from being involved in research. Which I did voluntarily .

But the most important part would be, that doctors know their limits and realise, that they are not trained scientists, though they know a lot of scientific facts. This must stop! It would improve the whole world of medicine to an incredible degree.

Hi DanME,

The question of weather a physician is a scientist or not is interesting. My experience in medical school and in practice doesn't demonstrate to me a correlation between how good a physician is by how much a scientist he/she are. The real question is what amount of time should be devoted to research in a medical school curriculum. As it stands, in the United States, for the most part, the first two years of medical school are devoted to the class room where physiology, biochemistry, anatomy, histology, microbiology, immunology, pathology, pharmacology, etc are taught. The last two years of school is general clinical training, How to interview a patient, write a rx, perform a physical exam, rotate on various clinical services like surgery, medicine, pediatrics, psychiatry, and other subspecialties. You receive some exposure to subspecialties like cardiology, ophthalmology, endocrinology, emergency medicine, dermatology, neurosurgery, urology, rheumatology, geriatrics, critical care medicine, infectious disease, neurology, etc. As you can see by this partial list of subjects a physician is expected to be exposed to is rather daunting.

So, what should be left out from the core curriculum so that there is enough time to perform research. Something has to give. There certainly many physician scientist who have research labs and publish frequently, but they are in the minority. I'm not a scientist, although I have developed many surgical techniques which I have taught resident which have been incorporated into their own practices. So what is more important to the average clinician, being a good scientist or a good clinician? I realize they aren't mutually exclusive but for many it is a choice of time, ability, desire to fit their individual talents.

Best,
Gary

 

[DanME]

Hi DanME,

The question of weather a physician is a scientist or not is interesting. My experience in medical school and in practice doesn't demonstrate to me a correlation between how good a physician is by how much a scientist he/she are. The real question is what amount of time should be devoted to research in a medical school curriculum. As it stands, in the United States, for the most part, the first two years of medical school are devoted to the class room where physiology, biochemistry, anatomy, histology, microbiology, immunology, pathology, pharmacology, etc are taught. The last two years of school is general clinical training, How to interview a patient, write a rx, perform a physical exam, rotate on various clinical services like surgery, medicine, pediatrics, psychiatry, and other subspecialties. You receive some exposure to subspecialties like cardiology, ophthalmology, endocrinology, emergency medicine, dermatology, neurosurgery, urology, rheumatology, geriatrics, critical care medicine, infectious disease, neurology, etc. As you can see by this partial list of subjects a physician is expected to be exposed to is rather daunting.

So, what should be left out from the core curriculum so that there is enough time to perform research. Something has to give. There certainly many physician scientist who have research labs and publish frequently, but they are in the minority. I'm not a scientist, although I have developed many surgical techniques which I have taught resident which have been incorporated into their own practices. So what is more important to the average clinician, being a good scientist or a good clinician? I realize they aren't mutually exclusive but for many it is a choice of time, ability, desire to fit their individual talents.

Best,
Gary

Since you have been a real doctor and not only a student like me, I think, you are the authority in this debate. But here is nevertheless my opinion.

The German system is a bit different.
The first two years you learn the scientific basics of medicine. Mainly physiology, biochemistry, anatomy (inculding histology) and psychology.
Then you have three years of clinical training in combination with classes of microbiology, immunology, pathology, pharmacology, statistics, ethics, medical economics (like how to run a hospital), medical sociology (like comparing different health systems in the world) and again psychology. You are "trained" in all subspecialities, you mentioned, though practical time is mostly limited to three weeks in each field.
Usually you extend the second part of three years to four years to start your doctorate in a field, you are interested in. Also you have to do an optional advanced course in a field, you like. You can do everything from ethics to immunology. I did a course, which was called "the biology of cancer", which I loved and which was very much focused on research. The last year (usually the sixth or seventh) is your practical year. You do rotation in internal medicine, surgery and an optional field (like dermatology or psychiatry). After that you are have the final exams and you are officially a doctor and can start a career.

In theory the German system is not bad. I think, it maintains a good balance between clinical work and theoretical courses. I also like, that you are able to extend your knowledge in fields, you are interested in.

Back to our question, if a doctor should be a clinician or a scientist. Of course he should be focused on beeing a good clinician and this is much more important. I don't want us to be scientists. It's a completely different kind of work. What I want us to be is more aware of what science is and how the scientific world works. We should be trained to be cautious about the facts, we learn. A lot of them will stay facts, but some of the theories we learned in med school will be turned on their heads in our lifetime. A lot of doctors have never thought about the fact, that psychosomatics has indeed a very hard time to prove its main concept and fails at a very basic level to do so. It cannot disprove it's own hypotheses. And furthermore psychosomatic studies have usually no control group. Also a lot of my friends, who are already working, know that homepathy doesn't work, but don't know, why it doesn't work and why it is so fundamentally flawed. Let's talk about statins. They reduce the risk of cardiovascular events, but usually only to the extend of 1-2%. This is the absolute risk reduction of the average patient. Not 50%, which is the relative risk reduction. Some doctors out there don't know the difference between the two, which is a shame. Then ME. The medical world has absolutely failed us for four decades! This is outragous. A doctor at med school told me that ME is psychological and was absolutely sure about that. Why? Because he is not able to do his own research and to critise studies. He wasn't even able to admit, that there are a lot of diseases out there, which medicine hasn't understood yet and has even wrongly classified. This is what I criticise.

My answer is education. Education in scientific and critical thinking. That's all. We should learn to be cautious sometimes and we should all be able to follow scientific debates. It's not about beeing actual scientists.

So what to leave out of the curriculum. I think, a lot of things we learn are to extensive and too detailed. Why do I have to learn every muscle of the body, if I am going to be an GP, an immunologist or an psychiatrist? Why do I have to learn about all psychological models, if I am going to be a surgeon? Makes no sense to me. We could concentrate on the basics, on structural knowlegde and the moment I want to become a surgeon I can learn about the 40 minor muscles, med school skipped. Also the moment, I become a psychiatrist, I can learn about the 10 different psychological models for anorexia. For the rest, it's enough to know the major symptoms and complications.

 

[DanME]

@DanME, did you get sick with ME while in medical school? How was it received by the elders?

Yes. Unfortunately, I had to stop studying in my sixth year, very shortly before my last exam.

We had a course about ME or CFS at med school, which was a catastrophe. The old it's all in our heads story and blaming the patient for staying sick. I critised the doctor, which trained us and at the end he revealed, that he handn't even read much about about the topic. He didn't know the science and spread misinformation. I complained at my university, but nothing happend.

The older clinicians I talked to, didn't believe CFS was a real illness. It was quite shocking for me, because I had all these severe symptoms. I tried to explain, but nobody really listened to me.

My younger friends, who already work, are more open minded. I mailed them the current research and they all say, it must be a physical disease (though I don't know, if they just want to be kind). I have two very good friends, one is a young psychiatrist and one a young neurologist. They are both very cautious about the topic and I educated them in symptoms and how to differ patients from other diseases. Two more on our side.

 

[jimells]

So to sum it up: A system of widespread abuse.

And yet the medical education system is the wrong place to look for an answer to why it is an abusive system that continues the abuse for generations. It is only another layer of an onion.

When I peel back all the layers I see a system of coercive hierarchies at the core. Is this really the only way to organize human societies? How about compassion and cooperation instead of domination and cutthroat competition, are these not possible to aim for?

Personally I think religion is the root of all evil. In my own simplified light-on-facts "History of the World" I picture a con artist convincing the rest of the tribe that if they just follow his orders (including doing the self-appointed priest's daily chores, of course) the mysterious gods will torment them a little less often.

If the gods continue to torment, well obviously more alms need to be placed on the alter. Soon the new priest will need subordinates to count and protect the loot, and to make sure everybody pays up.

It is no accident that European invaders and priests arrived together.

Umpteen thousand years later the seductive allure of power has metastasized into a global Empire determined to maintain control by smashing resistance one society at a time. Starting from the top and following the example set by Our Dear Leaders, the principles of domination and coercion permeate pretty much the whole society, including medical education.