21st century physicians. Scientists or Healers?

[ekimsurfer]

Now, I have been through graduate school prior to getting into medical school and studied a lot of molecular biology. I enjoy biochemistry also. That being said, I feel that the volume of molecular biology a medical student has to known/study is getting pretty rediculous compared to previous generations of doctors. I am thankful for medical/science advancements, but I feel that all of these minute details might hinder the performance of a physician and prevent us from actually understanding the underlying medical concepts and how to treat/heal them. I'm all for gaining knowledge and understanding, but I'm not planning on doing a PhD or hardcore research either. I understand the importance of a lot of these things, but some of this is bogus. Just my .02.

Any thoughts?

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[njbmd]

My graduate degree is in Molecular Biology and I participate in Continuing Ed to keep up with new developments. It's the changing nature of medicine.

 

[CCLCMer]

Now, I have been through graduate school prior to getting into medical school and studied a lot of molecular biology. I enjoy biochemistry also. That being said, I feel that the volume of molecular biology a medical student has to known/study is getting pretty rediculous compared to previous generations of doctors. I am thankful for medical/science advancements, but I feel that all of these minute details might hinder the performance of a physician and prevent us from actually understanding the underlying medical concepts and how to treat/heal them. I'm all for gaining knowledge and understanding, but I'm not planning on doing a PhD or hardcore research either. I understand the importance of a lot of these things, but some of this is bogus. Just my .02.

Any thoughts?

Don't let it get you down. The nice thing about med school is that if you don't like something you're doing right now, wait a month or two and you'll be doing something else. We had biochem/molecular bio our first block and got it out of the way. And since I go to CCLCM, which is a research program, I did actually have to spend two months working in a molecular bio lab. It was great experience, because now I am absolutely positive that there is no way I'll ever want to get a PhD in molecular bio. I'll pull all my nails out one by one before I ever run another Western blot.

 

[Benoit]

Doctors use science. Does that make them scientists? In my opinion, not so much.

 

[rickthetwinkie]

Doctors use science. Does that make them scientists? In my opinion, not so much.

I don't know if its as cut-and-dry as this, but I generally agree. Doctors are primarily practitioners.

 

[SomeDoc]

...but I feel that all of these minute details might hinder the performance of a physician and prevent us from actually understanding the underlying medical concepts and how to treat/heal them...

Don't you think this quote seems contradictory?

 

[zenman]

I don't know if its as cut-and-dry as this, but I generally agree. Doctors are primarily practitioners.

And doctors cure, or try to, and are not "healers."

 

[ekimsurfer]

And doctors cure, or try to, and are not "healers."

ok...ok. I knew I would get some slack for that statement.

From www.webster.com

Heal - 1 a: to make sound or whole <heal a wound> b: to restore to health
2 a: to cause (an undesirable condition) to be overcome.

Cure - 1 a: spiritual charge : care b: pastoral charge of a parish
2 a: recovery or relief from a disease b: something (as a drug or treatment) that cures a disease c: a course or period of treatment <take the cure for alcoholism>

I think they both apply.

I do feel that details are important but not to the the level of what the hydropathy index is of a certain protein or the entire step of certain cascades or pathways. I have already studied that and you better believe that once I start my residency that will be the last stuff I remember when I'm trying to do surgery (God willing). I do have a respect and appreciation for science/scientists as I have been one/am one. I love science and I love medicine. All I'm saying is that I would like to be a well-rounded physician whose knowledge lies more on the clinical side of things rather than the scientific side.

 

[ladynice]

Doctors use science. Does that make them scientists? In my opinion, not so much.

So who makes the science then?

 

[Law2Doc]

That being said, I feel that the volume of molecular biology a medical student has to known/study is getting pretty rediculous compared to previous generations of doctors.

Med school was 4 years then and it's 4 years now. The volume of information is similar, but the topics are different. Giving physicians background in this kind of stuff is important, not because they will become biochemists, but perhaps it gives them enough ammunition that they can recognize a patient with a biochemical pathway issue, or have a sense of how to explain to patients what they are doing when they use various gene therapies that are sure to emerge in the coming decades. And anyone who can't spell "ridiculous" shouldn't really be judging what is ridiculous.

 

[SomeDoc]

So who makes the science then?

Good one. I think benoit meant "physicians" when referring to "doctors".

On a different note, I think the use of science by physicians warrants the term "scientist", albeit more loosely when compared to application of the term to PhD's. We use hypotheticodeductive reasoning in our diagnoses, and use scientific findings as a function of our everyday clinical practices. Moreover, some of us perform formal research of our own, be it clinical or benchwork in nature.

 

[Benoit]

Sorry. Yes, I meant physicians.

Generally, we are not postulating or testing a hypothesis when diagnosing a patient. Instead, physicians are utilizing current explanations of how the world works (in our case specifically, the human body) in order to identify a disease or known deviation from the norm.

 

[IHeartNerds]

Say whaaat? I learned more biochemistry in undergrad than I did in med school.It's not like we remember any of it past Step I anyway...

One of the most important things about grad school turning you into a "scientist" with a PhD is the training of research skillz and critical analysis of scientific papers, etc. Mostly in med school we take things for granted. This is not necessarily good; it certainly doesn't make you a scientist overnight. That being said, if you seek out opportunities, I think you can become a physician-scientist, but I don't think it's the default pathway.

 

[PeepshowJohnny]

I think the big problem is that you start with the weirdo disease firsts and cover the common ones later.

For example, first year class like genetics, histo, immuno, and biochemistry, have you learning about rare one in a hundred million diseases like "Closter-Wildman-Ragner Disease" and "Hereditary Multifocal Lymphocytic Depletion Syndrome" because they exhibit some basic science principle.

It just seems silly to be focusing on those "trivia" diseases early (no matter how cool they are) when you've yet to learn about the "real" diseases which most doctors deal with.

(By the way, I just made up those disease, so don't feel bad if you never heard of them)

 

[Shredder]

Now, I have been through graduate school prior to getting into medical school and studied a lot of molecular biology. I enjoy biochemistry also. That being said, I feel that the volume of molecular biology a medical student has to known/study is getting pretty rediculous compared to previous generations of doctors. I am thankful for medical/science advancements, but I feel that all of these minute details might hinder the performance of a physician and prevent us from actually understanding the underlying medical concepts and how to treat/heal them. I'm all for gaining knowledge and understanding, but I'm not planning on doing a PhD or hardcore research either. I understand the importance of a lot of these things, but some of this is bogus. Just my .02.

Any thoughts?

Hey this is relatd to my thread nearby that I posted about the obsolescence of the physical exam. I support a trend toward science. It's more objective than the nebulous art of "healing". The results are better, I think studies will confirm this but I don't feel like pulling any up. Too many details are bad, they should be relegated to technology. There's no sense in having fallible humans try to be walking encyclopedias when computers and internet are everywhere.

Hallowed "diagnosis" is algorithmic. You can write a glorified c++ program to do it I feel.

 

[THP]

Hey this is relatd to my thread nearby that I posted about the obsolescence of the physical exam. I support a trend toward science. It's more objective than the nebulous art of "healing". The results are better, I think studies will confirm this but I don't feel like pulling any up. Too many details are bad, they should be relegated to technology. There's no sense in having fallible humans try to be walking encyclopedias when computers and internet are everywhere.

Hallowed "diagnosis" is algorithmic. You can write a glorified c++ program to do it I feel.

Unfortunately every person is different with different past medical history and particular combination of problems. Often the treatment of one problem will exacerbate another problem. At some point there is an art to finding a balance here. Also it seems like atypical presentations of diseases are more common than the "textbook" presentation.

 

[Shredder]

yeh, but there's a finite number of diagnoses and courses of treatments. Outliers can be treated by humans, the rest by c++ algorithm. Kinda like when you dial the phone and get automated menu vs real person. The menus are annoying but if they start charging for the humans I would take menus. sry this is kinda gibberish, gtg

 

[NonTradMed]

Physicians uses science to help people just like pastors use the bible to help people. The nature of our job does not change, but the tools we use to achieve our purpose does. Doctors used to be predominately a religious/shaman-like figure but with the advent of science, their path diverged from the superstitious beliefs which predominated the profession. But that doesn't mean our primary mission has changed. Only our methodology

 

[PeepshowJohnny]

Hallowed "diagnosis" is algorithmic. You can write a glorified c++ program to do it I feel.

I believe there have been infact studies about doctors using their clinical judgment vs. computer algorithms (little more compliated than C++ I believe) to diagnose people with data input. The ones I've seen the program did equally well or better than doctors.

The part where this breaks down, though, is the number of times I've seen physicians use hunches to their advantage. There have been numerous times where I've talked to a doctor after we've rounded on a patient and the doctor will bust out the "There's something funny going on with this guy/lady..." and low and behold what appeared to be a simple case turned out to be one more complicated.

Also, I'm not confident of human's abilities to interact with impersonal technology (the phone menu options mentioned before). I'm sure we've all had the experience of patients being blatantly wrong or contradictory in their history until corrected by a physician. "I've never had high blood pressure." "Your med list shows you're taking a beta blocker, an ace inhibitor, and HCTZ" "Oh, yeah, I guess I was". Stuff like that is going to screw with a computer program unless it's VERY advanced, while it's a relatively easy matter for a physician to get a sense someone isn't sharing the whole story.

 

[Law2Doc]

Also, I'm not confident of human's abilities to interact with impersonal technology (the phone menu options mentioned before). I'm sure we've all had the experience of patients being blatantly wrong or contradictory in their history until corrected by a physician. "I've never had high blood pressure." "Your med list shows you're taking a beta blocker, an ace inhibitor, and HCTZ" "Oh, yeah, I guess I was". Stuff like that is going to screw with a computer program unless it's VERY advanced, while it's a relatively easy matter for a physician to get a sense someone isn't sharing the whole story.

I think this is the real snag. Part of the point of building rapport with a patient is to get them to open up and tell you the whole story. Lots of stuff given out in a history is questionable. People sometimes lie, sometimes tell you what they think you want to hear, sometimes tell you what they think won't get them in trouble, sometimes simply don't remember, sometimes are suffering from delusion/dementia. Without someone building some form of a trust relationship with a patient, getting some semblance of a discourse going, you never can be confident that useful information will be given. And no computer program can ever go beyond the data given to it. I don't think we are talking outliers in this group -- this is the bulk, I think the computer is what will be able to deal with the outliers.

 

[rickthetwinkie]

And doctors cure, or try to, and are not "healers."

Okay, maybe I'm dumb or something. Could you explain what you mean?

 

[med_heidelberg]

Yea I agree the mol bio and biochem thing is a bit overdone. Especially at my school. Part of our boards are oral and I was asked to draw NADH (yea the molecular structure). I mean please, how is that relevant to the practice of medicine?

 

[BlackSails]

yeh, but there's a finite number of diagnoses and courses of treatments. Outliers can be treated by humans, the rest by c++ algorithm. Kinda like when you dial the phone and get automated menu vs real person. The menus are annoying but if they start charging for the humans I would take menus. sry this is kinda gibberish, gtg

Outliers can be treated by programs as well. All you need is a well-trained neural network. All you need to train it is practice cases.