How much worse can it get, my fellow future MDs

[wisdom2000]

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I read this on American Medical News yesterday (March 24-31 issue) and thought I'd get people's opinion on the problem.

When asked about differences between todays residents and residents some 20 years ago, Dr Mindum, a 83-year-old psychiatry resident, answered: "My fellow residents are not as sharp at physical diagnosis and not quite as attentive to the needs of the patient. They don't have time. I'm not sure medicine is as satisfying for them as it has been for me. They don't get to know the patient. My patients were always my friends."

This is to me some disturbing observation, and I keep hearing it over and over. I feel like the aspect of medicine that attracted me the most is being taken away. I know we live a different life today. With insurance company's MBAs regulating how much time you spend with a patient, medical school loan debt getting higher and higher, physicians can afford to see 5 patients a day anymore. But, we don't have to sacrifice the quality and beauty of the art of healing for financial reasons. I don't quite believe it's all about money either. Something else must be going on. I am not sure what it is however. Maybe you do. Please help me out here.

I'd like to hear what my fellow future MDs think.

 

[Blitzkrieg]

Originally posted by wisdom2000
When asked about differences between todays residents and residents some 20 years ago, Dr Mindum, a 83-year-old psychiatry resident, answered: "My fellow residents are not as sharp at physical diagnosis and not quite as attentive to the needs of the patient. They don't have time. I'm not sure medicine is as satisfying for them as it has been for me. They don't get to know the patient. My patients were always my friends."

I'd like to hear what my fellow future MDs think.

As a psychiatrist, I bet his patients were also bed partners..Tell me how you feel..take this roofie...whose your daddy?

 

[VienneseWaltz]

An 83-year-old resident? Are you sure?

 

[Naphtali]

Hey WV, lay off! Maybe he was an MD/PhD.

-Naphtali ("Hey, maybe I'll be a resident by the time I'm 83...")

 

[VienneseWaltz]

Originally posted by Naphtali
Hey WV, lay off! Maybe he was an MD/PhD.

-Naphtali ("Hey, maybe I'll be a resident by the time I'm 83...")

 

[Fenrezz]

Since you asked for MD opinions, naturally I felt obligated to chime in.

Personally, the fact that doctors are less caring nowadays is a natural consequence of medical schools focusing more on numbers than anything else (I'm including DO schools as well). If a school decides to accept a person with incredible stats, who spent 4 years cooped up in a library earning them, how do they expect them to have exceptional people skills? It's a trade off, in my opinion.

On average I believe the better the stats of any individual person, the less 'people-friendly' they will be. I've seen this with my own eyes. Keep in mind, I said 'on average'. This doesn't apply to everyone, obviously.

As far as residents not being as sharp, I just simply don't buy it. That may be his opinion, but I have no doubt the medical students nowadays are probably smarter than those 20 years ago, if you compared straight numerical averages.

I wouldn't worry about it. Whatever idealism you have about medicine now will be long gone before you start your residency. At that point you'll have a more realistic view of your chosen profession because you'll have more experience with it. You get out of all this what you put in to it.

 

[X]

1. Residents and students today are much brighter and sharper than those twenty years ago. This just has to do with the amount of knowledge that has been accumulated in the past twenty years. 20 years from now they will be smarter, on the average.

2. No the stats have nothing to do with personality. Take any field (including entertainment) and you will have people who have great sociable personalities and you will have others that are not good with people. Just the way the world rotates (or was it the cookie crumbles).

3. No one is sacrificing quality for financial reasons and no it is not all about the money either. You have hospitals that are expensive to maintain, a staff that needs to be paid, machinery that is necessary and very expensive (add lawyers into the equation for disaster). All these have costs. If you practiced medicine the old way, in today's world you will go broke and the hospital will go out of business and everyone loses (especially the patients). There are benefits: better equipment, better medications, better education, etc. Medicine cannot be practiced the same way because the rules of the game have changed.

Now this doesn't mean that the current system can't use a major change. It can, but idealism never gets anywhere.

There are many ways to change the current system. First and foremost, policy to take care of frivolous lawsuits and limits on settlements. Some of these are ridiculous. They put 12 jurors on to decide the fate - I would argue that most people are not equipped to make these decision and putting 12 of these guys on is a disaster.
Second, stop the wastage. There is a huge waste of financial resources in the EMS system. I don't know if people see this yet, but it is ridiculous. I am not saying that we don't need an EMS system, if you want to discuss this in detail, let me know.
I sound like I am preaching. 😀


X

 

[lattimer13]

Originally posted by X
...Second, stop the wastage. There is a huge waste of financial resources in the EMS system. I don't know if people see this yet, but it is ridiculous. I am not saying that we don't need an EMS system, if you want to discuss this in detail, let me know...


X

X,

how do you figure there is a "huge waste" of finances on EMS systems? i'm truly interested in hearing your thoughts on this. let me know.

 

[wisdom2000]

Hi X,
I am not sure I know what you mean by this: "There is a huge waste of financial resources in the EMS system. I don't know if people see this yet, but it is ridiculous. I am not saying that we don't need an EMS system."
A little elaboration, please.

By the way, I think you made a good point in saying that the world has changed and so has medicine. But, I am afraid the explanations you offered are as much financially based as I thought they would be.

 

[Gleevec]

Originally posted by Fenrezz
Since you asked for MD opinions, naturally I felt obligated to chime in.

Personally, the fact that doctors are less caring nowadays is a natural consequence of medical schools focusing more on numbers than anything else (I'm including DO schools as well). If a school decides to accept a person with incredible stats, who spent 4 years cooped up in a library earning them, how do they expect them to have exceptional people skills? It's a trade off, in my opinion.

On average I believe the better the stats of any individual person, the less 'people-friendly' they will be. I've seen this with my own eyes. Keep in mind, I said 'on average'. This doesn't apply to everyone, obviously.

As far as residents not being as sharp, I just simply don't buy it. That may be his opinion, but I have no doubt the medical students nowadays are probably smarter than those 20 years ago, if you compared straight numerical averages.

I wouldn't worry about it. Whatever idealism you have about medicine now will be long gone before you start your residency. At that point you'll have a more realistic view of your chosen profession because you'll have more experience with it. You get out of all this what you put in to it.

This has been dealt with numerous times, so I will just summarize what has been said. But my main point is, the above post is crap and that stats have nothing to do with personality at all.

1. The argument that stats correlate to personality is completely *****ic. If we were observing a party and afterwards I asked you to guess what each person had for a GPA and MCAT, there is NO WAY you could tell who was who. Sure, an arrogant person might have a higher stat line, but what if he had lower stats and is lying? There are tons of contigencies like these that make it near impossible to correlate stats to personality.

2. The people who make arguments like this have probably had a bad experience with a couple arrogant people with high stats. That sucks, I too have dealt with this, but to say ON AVERAGE as if you had a sample size of the entire premed body throughout the US is completely misleading.

3. Interviews try to weed out the antisocial jerks, but of course interviewers can be misled.

4. If you have a problem with people studying hard in the library, you are going to hate almost EVERYONE at your med school during their first two years.

5. Does that mean that someone who took the MCAT and got a 25 the first time he took the MCAT, a 30 the next time, and a 33 the next time-- that over a period of a year and a half he became a huge dingus? So anyone who takes the MCAT again with the goal of improving is automatically a gunning antisocial jerk?

No aspect of statistics or any quantifiable measure can tell you anything about someones personality. If it could, we would have true artificial intelligence by now. People are people. Some people with high stats are jerks, some are not. Some people with low or moderate stats are jerks, some are not. The notion that someones stats has anything to do with personality is ridiculous. It is extremely naive to make your generalizations about ALL premeds based on a few people you know, and it is even more dangerous to say ON AVERAGE as if you had access to the scores and personalities of a good majority of med applicants.

Also, if you really think stats are inversely correlated to personality, Im sure med schools with their extensive amount of data would have figured this out by now as well and would reject people with high scores. We would all take test prep courses to learn how to pick the WRONG answer every single time.

So yeah, nothing about stats relates to personality at all. But if you believe so, I have some beachfront property to sell you in Arkansas.

 

[wisdom2000]

For those who asked. Yes, Dr Gordon Mindrum is a 83-year-old resident. He is "the leading contender to be the oldest medical resident in the United States" AMNews. He got his MD a little over 50 years ago. But recently went back for a specialty in addiction psychiatry. He was previously an internist.

Here the link, http://www.ama-assn.org/sci-pubs/amnews/pick_03/prsd0324.htm

 

[Fenrezz]

Originally posted by Gleevec
This has been dealt with numerous times, so I will just summarize what has been said. But my main point is, the above post is crap and that stats have nothing to do with personality at all.

1. The argument that stats correlate to personality is completely *****ic. If we were observing a party and afterwards I asked you to guess what each person had for a GPA and MCAT, there is NO WAY you could tell who was who. Sure, an arrogant person might have a higher stat line, but what if he had lower stats and is lying? There are tons of contigencies like these that make it near impossible to correlate stats to personality.

And that's why I said on average, which means you can say everyone, and which also means you can't point out any one person and be right all the time.

2. The people who make arguments like this have probably had a bad experience with a couple arrogant people with high stats. That sucks, I too have dealt with this, but to say ON AVERAGE as if you had a sample size of the entire premed body throughout the US is completely misleading.

Actually I've had mostly good experience with some of my smarter classmates, but that doesn't mean I don't notice things. Most of my smarter undergrad and medical school classmates are very anal and pretty competitive. They obsess about grades all the time. Doesn't mean they aren bad people, but after being in different schools for a few years you get to notice a trend. Five different schools over a 10 year period makes it an appropriate sample size. If you think I need a sample size that includes every pre-med in the US, you might want to consider taking a statistics class and brush up on the basics. I'm not saying I did a scientific survery, these are all just observations and opinions.

3. Interviews try to weed out the antisocial jerks, but of course interviewers can be misled.

4. If you have a problem with people studying hard in the library, you are going to hate almost EVERYONE at your med school during their first two years.

I never said I hated anyone. I only made the comment that people like that have a tendency to be more antisocial than people who do not spend all their day in the library. I hate to break this to you, but this is common sense.

5. Does that mean that someone who took the MCAT and got a 25 the first time he took the MCAT, a 30 the next time, and a 33 the next time-- that over a period of a year and a half he became a huge dingus? So anyone who takes the MCAT again with the goal of improving is automatically a gunning antisocial jerk?

Good Lord, man, did you actually read my post? Where did I say that anyone is an dingus for anything? And once again, I said ON AVERAGE. Which means you can't qualify every specific detail to everyone who falls under the category.

A gunning antisocial jerk? Man, don't sound so defensive. If you spent your whole life in the library then all you're doing with this post is proving my point.

No aspect of statistics or any quantifiable measure can tell you anything about someones personality. If it could, we would have true artificial intelligence by now. People are people. Some people with high stats are jerks, some are not. Some people with low or moderate stats are jerks, some are not. The notion that someones stats has anything to do with personality is ridiculous. It is extremely naive to make your generalizations about ALL premeds based on a few people you know, and it is even more dangerous to say ON AVERAGE as if you had access to the scores and personalities of a good majority of med applicants.

So let me get this straight. After making observations about students for over 10 years, you're telling me I can't come up with an opinion based on those observation? How exactly is that dangerous? I say what I feel, and some people take it for what it's worth, and others, I won't say who, get offended because they feel they fall in that category. 😉

Again, if you knew anything about statistics, you would realize you don't need a majorty of the target population to come to a conclusion. A small sample size taken at random is enough. I only observed what I've seen around me, in 4 different cities and 5 different colleges. I'd say that's fairly random.

Also, if you really think stats are inversely correlated to personality, Im sure med schools with their extensive amount of data would have figured this out by now as well and would reject people with high scores. We would all take test prep courses to learn how to pick the WRONG answer every single time.

Now there's something I would expect a pre-med to say.

So yeah, nothing about stats relates to personality at all. But if you believe so, I have some beachfront property to sell you in Arkansas.

Son, I've lived in Miami all my life. I would smoke you on a beach front property deal! 😀

 

[wisdom2000]

I have to say that I agree with Fenrezz, to a certain extain, unfortunately. With intelligence usually comes arrogance, superiority complex, and the like. I don't know how much antisocial that makes you, but it can easily be seen as such when dealing with patients.

I do not however agree too much with Fenrezz on this one: "Personally, the fact that doctors are less caring nowadays is a natural consequence of medical schools focusing more on numbers than anything else." I don't believe med schools will ever stop or should ever stop focusing on numbers. Medicine does require a certain level of intellectual capacity (I will not get started on differences between that and test taking ability, please). But, considering adcoms only have a limited set of criteria to base their recruitment process on, it is almost impossible to propose a better plan. I do however think that adcoms overlook a lot of personality flaws because of fierce competition among schools. But on the other hand personality assessment is not nearly perfect, so there again, who is to really say.

I think adcoms need to come up with better ways to distinguish between test performance and intellectual capacity, then seriously factor in one's personality, and worry less about who will get the best Board Scores.

 

[MichiMO]

I think the problem is not necessarily high stats, but lack of well-roundedness...this tends to be what makes people less able to relate to their patiends simply from the "you are comfortable with what you know" sort of standpoint. I don't think this is something that has been missed my medical schools either...hence the recent trend towards admitting people of varied majors, age, sex, race, life experience.
As for people with high stats, I am sure their social abilities are varied, just like everything else, but I don't think you can ignore the trend that people who are very focused on "the numbers" will tend to be doctors who focus more on numbers than people. I don't know if that makes any sense...it is just a pesonality trend I have noticed.
I also think part of the reason medicine has become so impersonal is because it has become so technology based. I am not debating here whether this is a good or a bad thing, but it does tend to put a distance between doctor and patient.
Finally, I think there will always be resistance among pre-meds, med. students, and doctors to allowing people into medical school with lower stats, because there is that sentiment of "if I worked my ass-off and spent nights in the library instead of having fun in order to get into medical school, everyone else should have to too." I personally find that sort of attitude childish and silly. We all know that numbers are not a complete indication of what sort of doctor someone will make and we should trust that accredited medical schools are good enough that someone who was not mentally capable of being a doctor would not be able to make it through the classes.

 

[Fenrezz]

Originally posted by wisdom2000

I do not however agree too much with Fenrezz on this one: "Personally, the fact that doctors are less caring nowadays is a natural consequence of medical schools focusing more on numbers than anything else." I don't believe med schools will ever stop or should ever stop focusing on numbers. Medicine does require a certain level of intellectual capacity (I will not get started on differences between that and test taking ability, please). But, considering adcoms only have a limited set of criteria to base their recruitment process on, it is almost impossible to propose a better plan. I do however think that adcoms overlook a lot of personality flaws because of fierce competition among schools. But on the other hand personality assessment is not nearly perfect, so there again, who is to really say.

I think adcoms need to come up with better ways to distinguish between test performance and intellectual capacity, then seriously factor in one's personality, and worry less about who will get the best Board Scores.

Don't get me wrong, I'm not criticizing medical schools for choosing numbers over personality. I agree, there is no real way to tell who would make a good doctor and who wouldn't based on MCAT score and a single interview. I'm also not saying it's bad a bad thing per se, I was only pointing out that that's the way it is.

I was responding to the original poster's thread about how residents nowadays don't respond to their patients needs like they did 20 years ago. I don't think technology has anything to do with it, because in the end, it's the doctor who has to deal with the patient, and from what I've seen, patients are treated more like customers than anything else. Not only have I seen it in the hospital where I volunteered, but the nurses I've talked to have told me some of the things they experienced with doctor patient relationships, and I've been made to feel like that myself.

One thing that really disturbed me during the whole process of applying to medical schools: I had 3 separate doctors tell me I shouldn't go to medical school because the money is not what it used to be. 2 of them spent more than an hour trying to talk warn me about what I was getting in to. It never occurred to them that money might not be the number one reason I want to be a doctor.

 

[Ryo-Ohki]

Admissions candidate #1: I want to be a brain surgeon because I?m really nice and I love kids! *big smile*


Some of you won't be happy until we turn the admissions process into a Miss America competition. Bunch of pansies.

 

[Fenrezz]

Originally posted by Ryo-Ohki
Some of you won't be happy until we turn the admissions process into a Miss America competition. Bunch of pansies.

And then there's always that viewpoint.

 

[Ryo-Ohki]

It's my Dr. Cox impression.

 

[VienneseWaltz]

I'm going to take what any 83-year-old says with a grain of salt. Of course an MD who has been practicing 50+ years is going to find my diagnostic skills inferior to his and will likely misremember his relative preparation for medicine at my age. I've heard too many complaints from younger physicians that older physicians are reluctant to embrace protocol that evolves after their training to care what an older doc who doesn't know me thinks of my bedside manner. I think both younger physicians and older physicians have a lot to learn from each other.

I also agree with Ferenzz's point that a lot of physicans who entered, say, 15 years ago got into it for the money. I've had a lot of people try to talk me out of it, too, primarily because the money isn't so good. I would imagine people who go into it for this reason aren't so good with patients, especially if they're disgruntled. I don't think the MCAT has so much to do with it. I had a friend, who actually is very nice but hard to get out of his shell, score a 37 on the MCAT with a 4.0 from Duke and interesting ECs/work experience. He nonetheless faced limited choices for med school, which I think must have been the result of his interviews.

 

[lil pook]

Originally posted by Ryo-Ohki
Admissions candidate #1: I want to be a brain surgeon because I?m really nice and I love kids! *big smile*


Some of you won't be happy until we turn the admissions process into a Miss America competition. Bunch of pansies.

....and my talent is running separation columns while standing on my head. Oh, and yeah, I want world peace.

 

[X]

These sort of things take a good amount of writing to discuss. So I am going to write a quick article about the problems in the EMS system. I am not an expert on the system, but some of the problems are obvious so I will point these out. However, I am NOT going to post this on a message board or anything of the sort. So I will PM it to those that are interested (the two or three people above) and anyone else that wants to read it just say so here or PM me.
I will write it late tonight.


X

 

[Moneyless]

I've been following this thread and I'd like to read ur article X

 

[Thewonderer]

Originally posted by X
These sort of things take a good amount of writing to discuss. So I am going to write a quick article about the problems in the EMS system.

Isn't the issue mainly about the fact that it is much "cheaper" to do preventive care than to allow a disease to progress and have the patient ending up using emergency room as last resort (and by that time, the illness has progressed to a stage where cure is very expensive)?

Also, ER docs often order a wide array of tests just to save themselves from malpractice lawsuits (but that also happens to docs in other fields as well).

Not to dwell on that point but I do detect a correlation between numbers and personality as well 🙂

 

[X]

thewonderer,

sure that is an area that is a huge problem. But you are talking about a problem that is hard to fix. The stuff I am talking about, I doubt you have heard of these problems, are problems that can be fixed.
Unfortunately, the one you mentioned is a hard fix. Too much social and economic factors involved. How do you get these people to get preventive care? and how does it become affordable (I know the long term benefits are there, but still affordability in the short run is still a dilemma)?


X
ps. I am going to start working on the article right now, I have work very early in the morning, so I may not finish, but I promise to finish it asap and get it your way.

 

[X]

Ok I wrote it. Some things though

1. I am not an expert on this and some of my knowledge is limited. I don't have access to statistics etc so please take this into account

2. this is just me writing as fast as i could type. Thus i didn't edit for grammer and there could be better organization...but it's not for publication so it doesn't matter.

3. there is a lot more, but i think you should get a very general idea. it already became over 3 pages single spaced so i am stopping abruptly.

Let me know what you guys think - I am sending this to those that indicated interest. I had told myself that I wasn't going to write this, but oh well.

X

 

[MD2b06]

Originally posted by Fenrezz


On average I believe the better the stats of any individual person, the less 'people-friendly' they will be. I've seen this with my own eyes. Keep in mind, I said 'on average'. This doesn't apply to everyone, obviously.

Actually, I've found the reverse to be true after starting med school. On average, the higher the stats of an individual, the less they have to study, and the more time they have for those outgoing social activities that make them people friendly. I've got lots of friends w/ MCAT's in the mid to upper 30's in med school, and they're all chillin. I've also got lots of friends with lower MCAT's, and I'd say they're not as "people friendly," mainly b/c they are constantly stressed about competing against this group of high achievers. They're less likely to share notes, give you a heads up about what was stressed in lecture, etc. Obviously, this doesn't apply to everyone though.

 

[wisdom2000]

This thread is really about critics saying that doctors these days are not as attentive to the needs of their patients, and especially about this 83-year-old physician who said that residents nowadays are not a sharp at taking physicals and that medicine is not as satisfying as it used to be.

The discussion has been great so far, but it's starting to deviate a little bit. It would really be great to hear future MDs reactions to those comments.

Keep posting.

 

[pocwana]

Originally posted by X
There is a huge waste of financial resources in the EMS system.

If we, as future MDs, didn't have to worry about money, I believe we could get to know our patients better.

And regarding EMS, at least in Los Angeles County, an Engine with at least 3 firefighters, a Squad Truck with at least 2 paramedics, and an ambulance with at least 2 EMTs, respond to every medical emergency medical call. Why we need all that for a 45 year old man with abdominal pain, I have yet to figure out. This is just one aspect of EMS, but if anyone wants to call that something other than

Originally posted by X
a huge waste of financial resources in the EMS system.

please explain your take on it.