Where has the science gone?

[OTheHorror]

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I just started medical school and am really discouraged/turned off by the enormous amount of doctor/patient/touchy-feely stuff already...

We have almost spent as much time in motivational lectures/watching doctors talk to patients and dissecting communication skills than in our basic science courses.

One day, we literally sat in a chair for almost three hours watching videos of patients talking about how they'd like the doctor to talk to them, where they're comfortable with the doctor standing, etc....

Now, don't get me wrong. I know this is necessary, but I don't feel like I need to be lectured on these things, especialy at the expense of core sciences...why can't I just learn them as I go during third year? They're teaching us the science of communication and it's really interfering with my ability to study important things like biochemistry/anatomy...

I'd like to know what your school does as far as non-science based courses such as communication skills, how to be a doctor, things like that...

Is every school like this?

 

[daisygirl]

I just started medical school and am really discouraged/turned off by the enormous amount of doctor/patient/touchy-feely stuff already...

We have almost spent as much time in motivational lectures/watching doctors talk to patients and dissecting communication skills than in our basic science courses.

One day, we literally sat in a chair for almost three hours watching videos of patients talking about how they'd like the doctor to talk to them, where they're comfortable with the doctor standing, etc....

Now, don't get me wrong. I know this is necessary, but I don't feel like I need to be lectured on these things, especialy at the expense of core sciences...why can't I just learn them as I go during third year? They're teaching us the science of communication and it's really interfering with my ability to study important things like biochemistry/anatomy...

I'd like to know what your school does as far as non-science based courses such as communication skills, how to be a doctor, things like that...

Is every school like this?

Get used to it.

It seems that many med schools are putting a substantial effort into training humanistic physicians. I actually liked this stuff since it was a diversion from the typical binging and purging of the basic sciences. I also liked it since I felt that many med students do need to be exposed to this aspect of medicine.

However, I've found that the humanistic approach (specifically the really touchy-feely stuff such as talking to your patient for an hour) is thrown right out the window once you start third year. I have not started third year, but many of my friends (from my school) have told me that they were reamed out by attendings if they practiced the majority of what they learned in the behavioral modules.

 

[EctopicFetus]

Now I recently started 3rd yr and let me say many things are done daily my numerous attendings that I find uncomfortable. The touchy feely stuff is necessary cause many in the medical field are completely lacking when it come to interpersonal skills. Dont worry in the next couple of weeks they will drop this crap and hit the core stuff hard. Keep in mind you will forget all this by the time 3rd yr starts and your brain recovers from the boards.

 

[Harrie]

We had very little of that cr@p and a lot more basic science in the first two years. I think it depends on where you go to school. Schools that tend to produce more primary care docs are the ones that usually focus more on the softer side of medicine.

 

[Jaded Soul]

I hated the touchy-feely stuff too. In the first 2 years my school dedicated one afternoon per week to talking about cultural awareness, professionalism, etc. It was painful then and completely worthless, mostly because we were put through aggrevating exercises and discussions about stuff that was either common sense or so controversial that talking about it only caused arguments.

It got better in third year, but they still managed to make that touchy-feely stuff a part of some of the required clerkships where we had to write reflections each week. Even in fourth year, they're forcing us to spend a weekend in the classroom talking about more of this stuff--and they're making us do it twice.

I don't think it's unnecessary, but I hate being force fed all of it. All those hours I'll never get back and it's hasn't been useful when interacting with patients so far.

 

[Mumpu]

The reason communications skills are taught is because physicians badly suck at talking to patients. U of Colorado has a superb training program and it was a big relief and confidence-builder to practice telling bad news, to tease out history of domestic violence, and to work through difficult patients on standardized patients who allowed you rewind, try different approaches, and who gave you feedback. I came to medical school a) skeptical about this and b) with a lot of previous medical experience, and I still learned a ton. I've actually used many of the skills in personal relationships as well. This is FAR more useful than biochem and I will be a better physician because I've had this training.

The third year is for honing patient interview and physical exam skills, not for learning them. If you go into third year with bad habits and don't have a good intern/resident/attending who will slap them out of you, you will have these bad habits for the rest of your life.

If you think medicine is totally about science, I wonder if you've had any actual patient experience. Science takes place when you go back to the nurses' station to write your A/P. If you can't build rapport with even the most difficult patients, your science is worth didley-squat because you won't get a complete history and the patient won't cooperate for a thorough physical. A monkey can write for CBCs and MRIs.

Or to quote Voltaire, "Doctors give medicines of which they know little for diseases of which they know less to patients of whom they know nothing."

 

[daisygirl]

The reason communications skills are taught is because physicians badly suck at talking to patients. U of Colorado has a superb training program and it was a big relief and confidence-builder to practice telling bad news, to tease out history of domestic violence, and to work through difficult patients on standardized patients who allowed you rewind, try different approaches, and who gave you feedback. I came to medical school a) skeptical about this and b) with a lot of previous medical experience, and I still learned a ton. I've actually used many of the skills in personal relationships as well. This is FAR more useful than biochem and I will be a better physician because I've had this training.

That sounds like a great program. Unfortunately, the humanistic training at my school was much like Jaded Soul's. We had weekly sessions where we discussed the ethics behind such eclectic topics like assisted reproduction, physicians accepting gifts, and the right to die. Two years wasted on these ******ed topics. Don't get me wrong the topics are important, but not nearly as important as being taught the skills of how to recognize and deal with domestic abuse, child abuse, and telling bad news. I have never understood why time was wasted as it was at my school- somehow it seems like the faculty forgot that we are going to school to become doctors, and instead thought that we should be taught an 'intro to ethics' course.

My posts are becoming quite dismal on sdn lately. I guess I'm just really burned out and annoyed by my school's curriculum. 😳

 

[Sage880]

In my opinion, this doctor/patient/touchy-feely stuff is really important. The bad part is, you can't really teach it it seems for the most part. You can teach people to be professional in certain situations and you can make them more comfortable with doing things but for the most part, the people who are good at it were already good at it.

It's like teaching someone to be a salesperson. You can give them tips but some people are born with it and some aren't. For that reason I think the amount of classroom discussion for the soft-subjects should be minimal.

 

[OTheHorror]

Okay, so, so far one of you all have said something about doing this one afternoon per week...

We are stuck with this crap at least every other day, for sometimes hours at a time...

I would guess about 10 hours per week...being lectured about humanism...not to mention the reading assignments we're supposed to do outside of class

Isn't that a little much? I'm miserable...

My girlfriend says it will be good for me, though... 😛

 

[carrigallen]

My humble view is that the people who tend to be the most defiant about the ethics and humanism classes ought to be listening the most. I agree though that maybe it is a little bit overdone to start out with.

 

[doc05]

Okay, so, so far one of you all have said something about doing this one afternoon per week...

We are stuck with this crap at least every other day, for sometimes hours at a time...

I would guess about 10 hours per week...being lectured about humanism...not to mention the reading assignments we're supposed to do outside of class

Isn't that a little much? I'm miserable...

My girlfriend says it will be good for me, though... 😛

there IS no science in medicine, so get used to it. You will learn loads of crap over the next 2 years and forget EVERYTHING by the end of 3rd year.

and if your girlfriend says it will be good for you, she is probably right.

 

[Trisomy13]

to be honest, you will find all of the touchy-feely stuff to be much more valuable than anything you learn in biochemistry or anatomy. dealing with patients is probably 95% interpersonal skills, and 5% science. basic sciences are nice for Step 1, but if you come across as an inconsiderate ass on the floor, you are going to do poorly in this career.

you will never be able to fix a medical problem if you can't get your patient to cooperate with you.




and as someone above pointed out, it is usually the people who complain about these courses (bioethics, physician-patient interaction) that actually need them the most. if you haven't been taught this already, a number of malpractice suits could be avoided by simply having a good communicative relationship with your patients.

 

[Shinken]

I believe that all the "touchy-feely" stuff is supremely important. The fact that medical schools are starting to realize that is encouraging. My reasons:

1- The more you treat the patient as a human being with a life instead of a presenting chief complaint, the happier the patient will be (translation: decreased number of lawsuits).

2- The more you can get the patient to open up, the better the history you'll get from the patient. It's hard to diagnose a patient that won't disclose anything to you.

3- Physicians must recognize that a patient has to be treated with respect and dignity. It takes practice, and courses that reinforce that behavior can only help. After all, you can learn a ton of basic sciences on your own, but you can't learn good bedside manner on your own.

4- A happy patient that feels treated like a human being and that respects his/her physician will be more compliant when it comes to adhering to a drug regimen or course of therapy.

Just my thoughts.

 

[eklope2000]

My school also has tons of touchy feely stuff. I worry that in years to come, I will be able to make my patients feel so at ease, they'll tell me all their problems and worries, and I'll be so kind and gentle and ethical in my approach. Then, when they ask, "so what do I do?" I'll respond, "uuuuuuuuuuuuuuum... now I regret that medical school basic science lecture hours were more than quartered right around the time I started my training."

The medical school approach of the past may have been narrow-minded about the importance of teaching compassionate and humanistic medicine. But reallocating significant portions of our training from basic science to teaching this? Better to make medical school a year longer if that's what it takes than to drop so much science from the curriculum.

 

[Howard Roark]

good luck

 

[Mumpu]

Sage brings up a very good point -- your level of comfort. If you feel comfortable and confident with difficult issues, you will be much more likely to broach them with the patient and make it a good (or at least less painful) experience for both of you. Another advantage to being comfortable with patient communications is that it will make your life HUGELY more enjoyable. As a firefighter/EMT before med school I hated 10-minute transports of demented elderly patients, crazy people, drug addicts, and even trauma victims because I was so uncomfortable with them socially and emotionally. With the training I've had in patient communications, I can work up a demented old lady or a homeless guy with twenty diseases and actually have an enjoyable and educational experience.

You will absolutely hate medicine if you can't talk to sick people, and you will be a jaded a$$hole by the end of your third year of medical school and for the rest of your career.

Eklope, trust me, you will say "ummm" anyway. Diagnosis and treatment are not normally part of MSI and MSII curriculum -- that's what clinical years and residency are for.

FYI, I'm not a tree-hugging flower-arranging Birkenstock-wearing hippie. I was extremely skeptical of the curriculum just as you guys are. Then one day during the first year I tried a technique they taught us (talking to my grandmother with whom I'm very close, of all people) and Holy Batman, it worked like she had been briefed on what was supposed to happen. I agree that 10 hours a week is overkill (can you say "knee-jerk tools who work in administration") but if you learn the skills, they will serve you well.

 

[LuckyMD2b]

Better to make medical school a year longer if that's what it takes than to drop so much science from the curriculum.

Speak for yourself.

Maybe the problem is with you and not with the medical education system.

 

[MeowMix]

The touchy-feely stuff matters b/c you are going to need it a lot, and it takes a long time to develop bombproof skills which you can rely on even when you are really stressed.

It is a horrible experience to be a patient or a relative when someone is dying, if the doctors are scientifically competent but emotionally inept. My father died two weeks ago. Of the 14 doctors who saw him in the last 36 hours of his life, only 2 displayed any kindness or recognition of emotional needs of the dying man. It was truly awful to see yet another resident/attending group prance into the room, put him through the same damn questions about his medical history (info which was, of course, already in his chart), ask him if he was sure he didn't want to be resuscitated (also already in his chart), was he sure he didn't want another invasive test to try to diagnose a secondary problem, and then leave in a white-coat flourish, never having even once sat down at his eye level or spoken to him about anything other than his disease. And of course, none of these doctors actually seemed to communicate with each other either.

If you don't like the courses or they are ineffective, get on your school's curriculum committee and help create something that actually works.

 

[JattMed]

Communication skills,empathy etc are very very important things for every medical student to learn. What truly distinguishes a good doctor from the rest is his or her ability to apply the art of medicine to a particular patient or group of patients and not the science-that can be looked up in a book if needed. A lot of patients are frightened, disoriented, confused and upset. These issues are seldom looked into by doctors on wards and this is really an area that schools these days are trying to remedy. Eventhough Communication Skills lectures/tutorials are boring and seemingly useless to some people they are necessary. I have always made it a point to strike up a good rapport with a patient-especially when the attending/resident/intern is there conducting a clinical coaching session and he hasnt shown much empathy. At the very least I as a student can show some respect to the patient who is putting him/herself in a compromising/humiliating/vulnerable position so I can learn something. It amazes me to see some of my classmates who are totally inept in basic social skills taking pathetic histories like automatons. Be confident, be friendly, show some interest in the patients and they open up like a book-a history becomes effortless. Even for those that are good at social aspects of medicine it never hurts to get a 'refresher'. Heck it may even help out students who are socially inept in their own lives-they may be able to get a date.

 

[Mumpu]

MeowMix, I'm so sorry about your father and about the bad experience he had in his last few hours. 🙁

Seeing things like that (and having done it myself on a few occasions, much to my horror because I was convinced that surely I was not like that) really drove the point home. It took a lot of work (I'm not hypersocial by nature) but I'm getting better every day because I work on my patient skills every day.

Thank you for sharing!
D

 

[greets fr. nyc]

there IS no science in medicine, so get used to it. You will learn loads of crap over the next 2 years and forget EVERYTHING by the end of 3rd year.

and if your girlfriend says it will be good for you, she is probably right.

oh man, that cracks me up (lol)! ... so true, so true.

You will absolutely hate medicine if you can't talk to sick people, and you will be a jaded a$$hole by the end of your third year of medical school and for the rest of your career.

FYI, I'm not a tree-hugging flower-arranging Birkenstock-wearing hippie. I was extremely skeptical of the curriculum just as you guys are. Then one day during the first year I tried a technique they taught us (talking to my grandmother with whom I'm very close, of all people) and Holy Batman, it worked like she had been briefed on what was supposed to happen. I agree that 10 hours a week is overkill (can you say "knee-jerk tools who work in administration") but if you learn the skills, they will serve you well.

well spoken on both accounts, mumpu...

 

[zenman]

I'm reminded of the story about the Oriental Medicine doctor who was the envy of other physicians. It seems his patients did better than anyone else's and the other physicians were determined to find out why.

They observed the master physician for a while and discovered several interesting things. First, the master physician didn't really enjoy being a physician. Secondly, he did very little for his patients, usually just talking and laughing with them. He might occasionally insert a few acupuncture needles or prescribe a few herbs, but that was all.

The other physicians were dumbfounded! It seems they were doing as much as they could for their patients, inserting many needles and prescribing many herbs and other remedies. Why didn't their patients do better than his?

 

[Skialta]

I whole heartedly agree that you need to communicate with your patients. My complaint with the "social" aspects of the cirriculum at least at my school is the fact that each time we have one of those classes I feel it is the same thing hashed out with maybe only minor changes.

In my opinion by the middle of 1st year you have basically heard it all. If anything, more patient contact earlier would allow you to put what you have learned into practice instead of discussing the same old subjects.