A Fatally Flawed Medical Educational ModelComments on: --

By: balthus dors

balthus dors — Fri, 16 Jan 2009 14:31:39 +0000

please notify

By: balthus dors

balthus dors — Fri, 16 Jan 2009 14:30:35 +0000

To John Grohol
From Concerned Mental Health Worker
I think you should look into the scandal concerning fees for reprinting DSM-IV-TR Tables. APA refuses permissions unless exorbitant fees are charged If you write a paper/book you are charged up to $200 per table; members are charged nothing. The World Health Organization charges nothing for ICD tables. I know of one case where and author was charged over $5000 for a chapter in a book. He could not afford it and did not use the tables. Is this academic freedom? Psychologists and social workers have little or no input into the DSM; they must pay also. DSM makes over 12 milliion dollars per printing for the APA. Please look into this. One lone voice, such as mine, is not enough, and I fear academic reprisal if I speak out. Help please. Signed A Mental Health Worker and Academic

By: Berci Mesko

Berci Mesko — Sun, 07 Dec 2008 17:53:21 +0000

We try to work on a new model at the Medical Education Evolution community: http://medschoolevolution.ning.com/

Comments are welcome!

By: Christine Gray

Christine Gray — Fri, 05 Dec 2008 23:02:39 +0000

There is something fatally flawed about our medical culture. While many of the above points make logical sense, it is nonsensical to “train” folks by overworking them in a profession like medicine. It virtually guarantees that they will kill a patient through a fatigue error. They thus become wedded to the profession in a way that is probably not very healthy.

We have “normalized” this situation by artificial scarcity in medical schools. In other cultures, physicians (many of whom are women) are not so highly regarded. A doctor is a doctor is a doctor.

At least some portion of the rigors of American medical school are culturally manufactured, resembling a fraternity hazing more than professional development. Some of the less worthy cultural notions (and the notion of the Doctor’s Wife) probably spring directly from the Greek system, if not East Coast private school traditions.

The profession has a bad 19th century hangover.

By: Dan Hoch

Dan Hoch — Fri, 05 Dec 2008 22:13:19 +0000

I agree that there are significant differences between the jobs I mention and the apprenticeship that is a residency. Point taken, and I also admit that I’ve always written it off to a cost calculation by teaching hospitals. I’m not defending the system at all. My point is that even if we mandate that residents in training can’t work more than 12 hours or even 8 hours at a stretch, the culture remains. Many will still work on other projects and career activities instead of refreshing themselves.

Hmmm, maybe this point needs it’s own post with a title like “Why do doctors choose to become doctors?” I guess it would be nice to have some data to talk about though, not just my observations.

By: John Grohol

John Grohol — Fri, 05 Dec 2008 15:37:41 +0000

The difference between the professions you cite and residency is that residency is required as a part of the training process for a physician. There are many law opportunities that don’t require working 16 hours a day. And working hard to move up the corporate ladder (or to start or have your own business) is very different than the equivalent of a mandated apprenticeship where there really is no other choice.

The other point is that dealing with human lives is more valuable than practically any other profession I can think of. Literally, it can be a matter of life and death in terms of making a poor decision or a bad judgment. Shouldn’t we be expecting/demanding that the people who are making these judgments and decisions be at the top of their mental game? How can anyone who’s near the end of a 16 hour (or 30 hour) straight shift with an hour or two of sleep (maybe) be expected to fulfill these superhuman qualities?

By: Dan Hoch

Dan Hoch — Thu, 04 Dec 2008 21:57:50 +0000

What is up with our blog these days? Twice in the same day I’m going to take a position contrary to a post with which I basically agree. Yes, sleep deprived people make mistakes, and medical errors are deadly. I also agree that the culture is the problem, but I have a very different view of what causes that culture.

First, lot’s of people work 16 or more hours a day. Junior partners in law and consulting firms, small business owners, and even the reviled corporate executive or hedge fund manager. They work these hours willingly and for profit. This is also the case with resident physicians. No, they don’t make huge amounts of money, but they do stay on for reasons of self interest, often to take part in a conference, in the misbegotten belief that the patient needs continuity of care, to work on a research project/go back to the lab, or simply for the camaraderie. I have sometimes had to tell a resident to go home after 16 hours in the hospital. But did he/she sleep?

We can’t mandate sleep. The resident who leaves the hospital to go home and work on a grant, read, or even spend some quality time with her family is still going to come back to the hospital tired and make mistakes. It is the culture that does not reflect on the systemic cause for mistakes that is to blame, not the individuals who become inattentive, sleep deprived or otherwise impaired.

By: Terry Graedon

Terry Graedon — Thu, 04 Dec 2008 00:19:15 +0000

Not only are all those hours without sleep bad for residents’ health (physical and mental), but they also put the rest of us at risk when we must be patients. John, you’re exactly right that this is driven by bottom-line considerations as well as tradition.