Should applicants like "Dr. House" be allowed into medical school?

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I don't know if this hasn't been brought up - sorry, haven't read the whole thread.

The biggest problem with Dr. House is in real life, I can't see patients taking his advice. Sure, he's a skilled clinician... but people are stubborn, and I've seen over and over again where people did not follow what their physicians told them to do because they didn't like their physicians' attitudes. I've seen families fire our most experienced, very skilled intensivist because they didn't like what he told them about their loved ones' prognosis. They ended up with someone who'd only been out of fellowship for a year, who knows a lot less, but whom they liked much better because of his attitude.

Maybe we'd all pick competence over attitude on here because we know better, but the general population are idiots and will listen the nicest physician every time, regardless of competence. Unfortunately, those are the people we have to convince to take care of themselves so they can stay out of the hospital and quit driving our healthcare costs up, so we need to graduate more people that they will listen to.

Most medical problems can be prevented by taking your grandmother's advice. Eat less, exercise more and keep yourself hygienic, etc. Most of medicine is trying to get patients to perform these behaviors despite their inconveniences. A doctor like House would be completely ineffective and either have no patients or else no other group would want to take him because he is too high risk. Additionally, he would be hard to work with and would often end up missing important signs due to his arrogance.

Interpersonal skills MATTER a lot. Yes, even for fields like Pathology or Radiology where you have to convey your findings to the other medical staff. You have to be a person that other people want to work with.
 
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One way or another, Gregory Houses get admitted to medical school. They pass empathy training and milestones with flying colors, because they know how to dance.

People like House only work when they're insulated by their peers. I don't think we should actively recruit these kinds of people, because really, 90% of medical problems are related to chronic lifestyle choices, and you don't need a mental acrobat to solve them. I also don't subscribe to the 'customer is always right' turn our medical culture has taken. But when they do slip through, managed in the right way, they can do wonderful things.

Where we should recruit people like House is in medical research. It's a **** show in the lab anyways. Talk about egos. Brilliant people give us things like CRISPR, immunotherapy, and MRI machines. They leave a trail of grad students behind them, but the job needs getting done.
 
Most medical problems can be prevented by taking your grandmother's advice. Eat less, exercise more and keep yourself hygienic, etc. Most of medicine is trying to get patients to perform these behaviors despite their inconveniences. A doctor like House would be completely ineffective and either have no patients or else no other group would want to take him because he is too high risk. Additionally, he would be hard to work with and would often end up missing important signs due to his arrogance.

Interpersonal skills MATTER a lot even for fields like Pathology or Radiology where you have to convey your findings to the other medical staff.
Not to mention I'm sure hospitalized patients would complain about him on the communication with doctors part of the HCAHPS. Any smart hospital would revoke his privileges fast if he alone significantly drove down patient satisfaction scores and cost them a ton of reimbursement.
 
Not to mention I'm sure hospitalized patients would complain about him on the communication with doctors part of the HCAHPS. Any smart hospital would revoke his privileges fast if he alone significantly drove down patient satisfaction scores and cost them a ton of reimbursement.

There are 7 benefits to good interpersonal skills:

1. Less litigation
2. Creation of a friendly environment of the staff and faculty
3. Increased productivity
4. Improved patient care
5. Better teaching
6. Better Reputation
7. Better time management

Interpersonal skills

If I was running a hospital or a clinic, I would rather NOT have a doctor like House on staff.

One way or another, Gregory Houses get admitted to medical school. They pass empathy training and milestones with flying colors, because they know how to dance.

People like House only work when they're insulated by their peers. I don't think we should actively recruit these kinds of people, because really, 90% of medical problems are related to chronic lifestyle choices, and you don't need a mental acrobat to solve them. I also don't subscribe to the 'customer is always right' turn our medical culture has taken. But when they do slip through, managed in the right way, they can do wonderful things.

Where we should recruit people like House is in medical research. It's a **** show in the lab anyways. Talk about egos. Brilliant people give us things like CRISPR, immunotherapy, and MRI machines. They leave a trail of grad students behind them, but the job needs getting done.

I strongly disagree. Even as a researcher, you need to have some level of interpersonal skills to work with other staff.

Before medical school, I worked as a researcher and there was this one guy who was brilliant, but HATED by everyone in the building. As a result, he didn't last long nor did he get anything done.

All that happened was that he ended up leaving.
 
There are 7 benefits to good interpersonal skills:

1. Less litigation
2. Creation of a friendly environment of the staff and faculty
3. Increased productivity
4. Improved patient care
5. Better teaching
6. Better Reputation
7. Better time management
.

I definitely agree with #4. It has been my personal and professional experience that most good patient outcomes don't occur in one fell swoop--- that is, even when they get the rare diagnosis/perfect surgery/etc, this alone does not guarantee their recovery. If patients are unclear on things like discharge meds or activity restrictions, and they are uncomfortable speaking with their lead physician, issues will arise. Best case scenario, the physician has a team that can communicate these details for him. Worst case, the physician's bad attitude trickles down to the rest of the team. Typical case: pt is uncomfortable with physician, asks another member of the care team, care team member has to check with physician anyway, response to pt is significantly delayed.

Needless to say, very little good comes from a physician with poor interpersonal skills.
 
One way or another, Gregory Houses get admitted to medical school. They pass empathy training and milestones with flying colors, because they know how to dance.

They may get admitted, but they may not graduate. If they graduate, they may not make it through residency.
 
They may get admitted, but they may not graduate. If they graduate, they may not make it through residency.

Very true. My impression is people like House don't actually exist, they are great at the a-hole part, but don't exactly deliver miracles. And they're a pain to everyone around them.
 
I don’t think a shoemaker back in the days was ever fooled by his apprentice whom he later hired.

Perhaps med school applicants (selected on very relaxed/basic criteria) should do a full year of apprenticeship/internship... at hospitals, clinics, hospices, etc. under direct supervision/control of med schools.... before full selection/acceptance.
Otherwise, many good actors/bad candidates may slip through.
 
I don’t think a shoemaker back in the days was ever fooled by his apprentice whom he later hired.

Perhaps med school applicants (selected on very relaxed/basic criteria) should do a full year of apprenticeship/internship... at hospitals, clinics, hospices, etc. under direct supervision/control of med schools.... before full selection/acceptance.
Otherwise, many good actors/bad candidates may slip through.

I can be on board with this. All that would need to happen is that schools must require a letter from a volunteering experience, clinical or nonclinical, in order to assess humanism
 
I'm noticing that a lot of people leaning towards the brilliant/rude doctor are saying "if I were sick" and a lot of the people saying both are important are saying "when I was sick." Interesting.
I think it's easy to underestimate the vulnerability of the "sick role" from the outside looking in (I've done it myself). When you're at your most vulnerable, plus being scared/confused/in pain, having a brilliant doctor helps, but only to a point. Having a brilliant doctor that can also relate to you on a human level is vital (IMO) for truly comprehensive care.

Or, from a very reductive standpoint:
Do you want a chef who makes you a fantastic omelette while making fun of your weight and then throws it at you while insulting your reflexes?
OR
Do you want a chef who makes you a fantastic omelette and then hands it to you like a normal person?

People don't need their doctors to be emotional savants that counsel away all their fears, they just need them to be normal-ish human beings during patient-doctor interactions.
 
So what happens to people like Dr. House? Do they end up homeless as it seems every single job now requires "interpersonal skills"?
 
So what happens to people like Dr. House? Do they end up homeless as it seems every single job now requires "interpersonal skills"?

No one wants to work with an dingus. In League we say "You n00b, you feed". 🙂
 
I like working with them.

I know of no one that likes a toxic personality. I certainly don't want anyone nor does anyone I know want anyone who takes every opportunity to belittle those around them. I've done 24 hour call with great attendings and it is MUCH better than spending an hour with someone who has a personality problem.
 
They may get admitted, but they may not graduate. If they graduate, they may not make it through residency.

Some definitely get through residency. The interview is a one day facade that anyone can game. That being said, your attitude during residency determines your job prospects especially in the area of your residency program. If you're lazy or have an overall attitude problem you likely won't be staying in that area since the majority of the local groups hiring are comprised former residents/attendings of the program who - surprise, surprise - talk with their contacts in the program about the candidate.
 
Sorry to necrobump this, but JAMA just published another interesting editorial about this question called "Does Medicine Overemphasize IQ?" The authors appear to be unaware of the holistic review process that some adcomm members are pioneering. Here are the interesting parts:

"Everyone wants the best physician....[But] do the smartest students, as measured by science grades and standardized test results, truly make the best physicians?

Vitally important to the success of 21st-century clinicians are 3 capabilities: to (1) effectively lead teams, (2) coordinate care, and (3) engender behavior change in patients and colleagues. (Both 1 and 3 require negotiating skills.) Thus, effective physicians need both an adequate IQ and a high EQ.

For the 10% of chronically ill patients who consume nearly two-thirds of all health care spending,7 the primary challenge is not solving diagnostic conundrums, unraveling complex genetic mutations, or administering specially designed therapeutic regimens. Rather, physicians caring for chronically ill patients with several comorbidities must lead multidisciplinary teams that emphasize educating patients, ensuring medication adherence, diagnosing and treating concomitant mental health issues, anticipating potential illness exacerbations, and explicitly discussing treatment preferences.

These activities depend on listening, building trust, empathy, and delineating mutual goals. Chronic care management, in addition to sufficient intelligence, therefore primarily requires a high EQ.

Efforts to select medical students based on EQ have been largely absent from medical school admission criteria. Why? Historically, admissions committees have focused too much on academic training and pedigree.

Undoubtedly, EQ—like IQ—is at least somewhat genetic. Yet just as there are ways to improve general intelligence, so too are there ways to improve emotional intelligence. This suggests 3 important changes in 21st-century medical education. First, admissions committees must deemphasize IQ and increase the emphasis of EQ in the selection of medical students. This can be done by eliminating the irrelevant premed requirements of organic chemistry, physics, and calculus, while requiring training in psychology and leadership.

Second, medical school admissions should incorporate explicit evaluations of EQ. An important first step has been the recent modification of the MCAT, which now includes a section on the psychological, social, and biological foundations of behavior. To build on this change, admission committees should also consider incorporating model negotiation sessions as part of the interview process. Alternatively, medical schools might use techniques to assess EQ such as the Emotional and Social Competency Inventory or behavioral event interviewing techniques.

Third, medical schools should include more training for their medical students, focused not just on managing myocardial infarctions or the genetics of hypertension but explicitly on enhancing EQ. Medical students should be taught how to listen to their patients, encourage behavioral changes, and coordinate with team members in clinical settings.

It is time for medicine to reduce its emphasis on IQ. If medicine hopes to identify and train a phenomenal next generation of caring, effective physicians who can lead multidisciplinary teams and induce patient behavior change, the medical profession must start by recognizing the importance of EQ."
 
Sorry to necrobump this, but JAMA just published another interesting editorial about this question called "Does Medicine Overemphasize IQ?" The authors appear to be unaware of the holistic review process that some adcomm members are pioneering. Here are the interesting parts:

"Everyone wants the best physician....[But] do the smartest students, as measured by science grades and standardized test results, truly make the best physicians?

Vitally important to the success of 21st-century clinicians are 3 capabilities: to (1) effectively lead teams, (2) coordinate care, and (3) engender behavior change in patients and colleagues. (Both 1 and 3 require negotiating skills.) Thus, effective physicians need both an adequate IQ and a high EQ.

For the 10% of chronically ill patients who consume nearly two-thirds of all health care spending,7 the primary challenge is not solving diagnostic conundrums, unraveling complex genetic mutations, or administering specially designed therapeutic regimens. Rather, physicians caring for chronically ill patients with several comorbidities must lead multidisciplinary teams that emphasize educating patients, ensuring medication adherence, diagnosing and treating concomitant mental health issues, anticipating potential illness exacerbations, and explicitly discussing treatment preferences.

These activities depend on listening, building trust, empathy, and delineating mutual goals. Chronic care management, in addition to sufficient intelligence, therefore primarily requires a high EQ.

Efforts to select medical students based on EQ have been largely absent from medical school admission criteria. Why? Historically, admissions committees have focused too much on academic training and pedigree.

Undoubtedly, EQ—like IQ—is at least somewhat genetic. Yet just as there are ways to improve general intelligence, so too are there ways to improve emotional intelligence. This suggests 3 important changes in 21st-century medical education. First, admissions committees must deemphasize IQ and increase the emphasis of EQ in the selection of medical students. This can be done by eliminating the irrelevant premed requirements of organic chemistry, physics, and calculus, while requiring training in psychology and leadership.

Second, medical school admissions should incorporate explicit evaluations of EQ. An important first step has been the recent modification of the MCAT, which now includes a section on the psychological, social, and biological foundations of behavior. To build on this change, admission committees should also consider incorporating model negotiation sessions as part of the interview process. Alternatively, medical schools might use techniques to assess EQ such as the Emotional and Social Competency Inventory or behavioral event interviewing techniques.

Third, medical schools should include more training for their medical students, focused not just on managing myocardial infarctions or the genetics of hypertension but explicitly on enhancing EQ. Medical students should be taught how to listen to their patients, encourage behavioral changes, and coordinate with team members in clinical settings.

It is time for medicine to reduce its emphasis on IQ. If medicine hopes to identify and train a phenomenal next generation of caring, effective physicians who can lead multidisciplinary teams and induce patient behavior change, the medical profession must start by recognizing the importance of EQ."
Thanks for the interesting article.

I don't think it's a stretch to say that none of this is a surprise- physicians who are good team players, socially intelligent, and generally non-dinguses are in a better position to relate to patients and coworkers and deliver good care. However, IMO, it's important that studies explicitly show these conclusions given the reluctance of medical education to change (a la, the new MCAT kerfuffle)

I would hypothesize that any slow shift of medical education to focus on EQ would accompany the slow shift towards more humane treatment of medical students and residents. For this you would need studies as well, to counter the "uphill both ways for five miles in the snow back in my day" group. In short- does getting the **** beat out of you physically, mentally, and emotionally by the med ed system actually make you a better doctor? Or does it beat you down to the point where your EQ skills are struggling to survive in the face of exhaustion and depersonalization?
 
Sorry to necrobump this, but JAMA just published another interesting editorial about this question called "Does Medicine Overemphasize IQ?" The authors appear to be unaware of the holistic review process that some adcomm members are pioneering. Here are the interesting parts:

"Everyone wants the best physician....[But] do the smartest students, as measured by science grades and standardized test results, truly make the best physicians?

Vitally important to the success of 21st-century clinicians are 3 capabilities: to (1) effectively lead teams, (2) coordinate care, and (3) engender behavior change in patients and colleagues. (Both 1 and 3 require negotiating skills.) Thus, effective physicians need both an adequate IQ and a high EQ.

For the 10% of chronically ill patients who consume nearly two-thirds of all health care spending,7 the primary challenge is not solving diagnostic conundrums, unraveling complex genetic mutations, or administering specially designed therapeutic regimens. Rather, physicians caring for chronically ill patients with several comorbidities must lead multidisciplinary teams that emphasize educating patients, ensuring medication adherence, diagnosing and treating concomitant mental health issues, anticipating potential illness exacerbations, and explicitly discussing treatment preferences.

These activities depend on listening, building trust, empathy, and delineating mutual goals. Chronic care management, in addition to sufficient intelligence, therefore primarily requires a high EQ.

Efforts to select medical students based on EQ have been largely absent from medical school admission criteria. Why? Historically, admissions committees have focused too much on academic training and pedigree.

Undoubtedly, EQ—like IQ—is at least somewhat genetic. Yet just as there are ways to improve general intelligence, so too are there ways to improve emotional intelligence. This suggests 3 important changes in 21st-century medical education. First, admissions committees must deemphasize IQ and increase the emphasis of EQ in the selection of medical students. This can be done by eliminating the irrelevant premed requirements of organic chemistry, physics, and calculus, while requiring training in psychology and leadership.

Second, medical school admissions should incorporate explicit evaluations of EQ. An important first step has been the recent modification of the MCAT, which now includes a section on the psychological, social, and biological foundations of behavior. To build on this change, admission committees should also consider incorporating model negotiation sessions as part of the interview process. Alternatively, medical schools might use techniques to assess EQ such as the Emotional and Social Competency Inventory or behavioral event interviewing techniques.

Third, medical schools should include more training for their medical students, focused not just on managing myocardial infarctions or the genetics of hypertension but explicitly on enhancing EQ. Medical students should be taught how to listen to their patients, encourage behavioral changes, and coordinate with team members in clinical settings.

It is time for medicine to reduce its emphasis on IQ. If medicine hopes to identify and train a phenomenal next generation of caring, effective physicians who can lead multidisciplinary teams and induce patient behavior change, the medical profession must start by recognizing the importance of EQ."
The competencies the authors are suggesting we Faculty demand in applicants and med students have only been looked for for the the past, oh, 20 years.
 
Acting is not some mythical ability.

Many sociopaths are actually quite adept actors.

The thought that an interviewer can somehow weed out pervasive personality disorders in a 15-minute chat is laughable.

Remember, these people act their way into marriages routinely.

Could a 'HOUSE' get into med school and residency? EASILY. High IQ, so we can assume a 4.0 and >520 MCAT. That nets him interviews. All he has to do is put on a show for a few minutes.
 
Acting is not some mythical ability.

Many sociopaths are actually quite adept actors.

The thought that an interviewer can somehow weed out pervasive personality disorders in a 15-minute chat is laughable.

Remember, these people act their way into marriages routinely.

Could a 'HOUSE' get into med school and residency? EASILY. High IQ, so we can assume a 4.0 and >520 MCAT. That nets him interviews. All he has to do is put on a show for a few minutes.
While our radars are good, they're not perfect. Just look at the case of Dr Eugene Gu. I wonder what his interviewers and med school faculty are thinking now???
 
While our radars are good, they're not perfect. Just look at the case of Dr Eugene Gu. I wonder what his interviewers and med school faculty are thinking now???
goro, do you think admissions committees ever sense sociopathic traits from the application alone (pre-ii)?

also, what did Eugene Gu do? are you speaking of the fetal tissue transplants lol
 
goro, do you think admissions committees ever sense sociopathic traits from the application alone (pre-ii)?

also, what did Eugene Gu do? are you speaking of the fetal tissue transplants lol
Go read the thread about him in General Residency forum.

We do pick up on scary people. While many sociopaths are actually charming, some are creepy. You can't hide that.
 
Thanks for the interesting article.

I don't think it's a stretch to say that none of this is a surprise- physicians who are good team players, socially intelligent, and generally non-dinguses are in a better position to relate to patients and coworkers and deliver good care. However, IMO, it's important that studies explicitly show these conclusions given the reluctance of medical education to change (a la, the new MCAT kerfuffle)

I would hypothesize that any slow shift of medical education to focus on EQ would accompany the slow shift towards more humane treatment of medical students and residents. For this you would need studies as well, to counter the "uphill both ways for five miles in the snow back in my day" group. In short- does getting the **** beat out of you physically, mentally, and emotionally by the med ed system actually make you a better doctor? Or does it beat you down to the point where your EQ skills are struggling to survive in the face of exhaustion and depersonalization?

Thought-provoking questions. It's so easy to buy into the culture of celebrating how hard you're pushing yourself, when in reality, there's nothing to be proud of about shortening your own lifespan (and possibly those of patients due to fatigue-induced careless mistakes) by pushing yourself so hard that you fail to do appropriate self-care. The key is balance. What that looks like on a systematic level though, I do not know.
 
The competencies the authors are suggesting we Faculty demand in applicants and med students have only been looked for for the the past, oh, 20 years.

Acting is not some mythical ability.

Many sociopaths are actually quite adept actors.

The thought that an interviewer can somehow weed out pervasive personality disorders in a 15-minute chat is laughable.

Remember, these people act their way into marriages routinely.

Could a 'HOUSE' get into med school and residency? EASILY. High IQ, so we can assume a 4.0 and >520 MCAT. That nets him interviews. All he has to do is put on a show for a few minutes.

True true. The article makes it sound like they've never heard of holistic review, MMIs, CASPER, or non-clinical community service. To be fair, they did mention Mt. Sinai's HuMed program (I cut that out of my summary).

I was intrigued by their suggestion of using "Emotional and Social Competency Inventory or behavioral event interviewing techniques", but I don't know whether I agree with them. Part of me doesn't think this is necessary because I think the best judge of applicants' humanistic strengths is probably adcomm members interacting with them and using their intuition and judgment. (I also think it's a bit ironic to use a standardized test to quantify people's humanity, but anyway.) On the other hand, maybe standardized instruments like this would make the process more fair and less vulnerable to acting, as @RNthenDoc points out? I don't know. What do you think?
 
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