WSJ article: "Med School Needs an Overhaul"

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

seanm028

Transiently fascinated
7+ Year Member
Joined
May 7, 2016
Messages
337
Reaction score
494
Just read this article written by Stanley Goldfarb, a former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine, in the Wall Street Journal and thought it was interesting. I'm curious what people's thoughts are.

TLDR: Medical schools should "abandon" the idea that doctors can solve social injustices, and instead focus on giving them all a better education in public health.

Members don't see this ad.
 
Last edited:
  • Like
Reactions: 6 users
This?: Opinion | Med School Needs an Overhaul

I clicked your link and it went to a blank page. Not sure why.

Also, there is a paywall but the subtitle says "Doctors should learn to fight pandemics, not injustice."

Don't think those two are mutually exclusive and in fact, we are now seeing the virus impact certain sub-populations disproportionally than others. Evidence points to social injustices for this disparity.
 
Last edited:
  • Like
  • Dislike
Reactions: 17 users
This?: Opinion | Med School Needs an Overhaul

I clicked your link and it went to a blank page. Not sure why. Paywall though
Yeah, that's the same article. I guess WSJ doesn't give you 3 free views per month or whatever.

Anyway, I think these quotes pretty much sum it up:
Most medical schools don’t require students to do coursework on pandemic response or practical preparation for a widespread and sustained emergency. American medical training as a whole doesn’t include a strong grounding in public-health issues or disaster preparedness. Instead, two of the nine specific curricular requirements decreed by the body that accredits medical schools are focused on social issues in medicine, including “the diagnosis of common societal problems and the impacts of disparities in health care on medically underserved populations,” particularly “in a multidimensional and diverse society.” None mention public health or epidemics.

Above all, the medical profession should abandon the fantasy that physicians can be trained to solve the problems of poverty, food insecurity and racism. They have no clinical tools with which to address these issues.

If curricular reform is to come, it should take into account the essential role physicians must play in a public-health crisis. It should aim to produce physicians who are prepared to help battle deadly pandemic diseases like Covid-19.
 
  • Like
Reactions: 2 users
Members don't see this ad :)
I hate to comment without being able to read the full article (I can't seem to find anyway to get through the paywall), but this sounds like an absolutely insane point of view.

Obviously learning about epidemiology is super important, but I have no idea why learning about public health and learning about how to improve social injustices/health disparities are mutually exclusive.

In my opinion, the fact that prominent doctors think learning about health disparities/discrimination/social issues is useless shows just how badly we need these topics to be a part of our medical education.
 
Last edited:
  • Like
  • Dislike
Reactions: 33 users
Yeah, that's the same article. I guess WSJ doesn't give you 3 free views per month or whatever.

Anyway, I think these quotes pretty much sum it up:

Ahh okay. I don't understand the dichotomy, to be frank. Lots of public health professionals study pandemic preparedness as well as social inequality. The writer doesn't understand public health. The PH professionals I work with usually work in social injustice (homelessness, racism etc) are now prioritizing COVID-19 research. Projects are coming up looking at racial disparities in COVID-19 prevalence and we see it in our data.

We can learn both lol.
 
  • Like
Reactions: 4 users
Ahh okay. I don't understand the dichotomy, to be frank. Lots of public health professionals study pandemic preparedness as well as social inequality. The writer doesn't understand public health. The PH professionals I work with usually work in social injustice (homelessness, racism etc) are now prioritizing COVID-19 research. Projects are coming up looking at racial disparities in COVID-19 prevalence and we see it in our data.

We can learn both lol.
Also, it seems like this guy wrote an article with similar themes last year:

Opinion | Take Two Aspirin and Call Me by My Pronouns

Can't wait for next year's article: "Racism in medicine will go away if we just ignore it!" :rolleyes:
I agree. While there may be more room for education pertaining to public health emergencies, it seems like the author is creating a false dilemma. To be perfectly honest, he almost sounds bitter to me.

I'm curious to hear the other side of the argument, though.
 
Wasn't he the same person who suggested cutting out social justice issues from the medical curriculum entirely?
:excuseme: -Yikes-

An Op-Ed on that piece from last fall.
 
  • Like
  • Dislike
Reactions: 1 users
I read it in hard copy this morning. If I wasn't up to my eyeballs in teaching and administrative duties, I'd have written a letter to the editor straight away. The author completely misses the point that health disparities as we are seeing with Covid-19 are linked to the social determinants of health that he doesn't believe medical students need to know about. You can learn how to titrate insulin and when to prescribe albuterol for asthma but if you fail to appreciate how food deserts contribute to the prevalence of diabetes and how housing and asthma are linked, you won't realy be able to help patients control their chronic conditions. Plus, doctors still have some social standing and still get some respect from the public and from some public officials and can use their status to promote positive social change, if they are aware of the issues and know how to be advocates for patients and communities.

This whole focus away from social determinants of health and toward disaster preparedness reminded me of a documentary film I saw called "Cooked Survival by Zip Code" Cooked: Survival by Zip Code | Our Films | Independent Lens | PBS Check it out.
 
  • Like
  • Love
  • Dislike
Reactions: 44 users
I think the article has obvious shortcomings, but also makes some excellent points. No matter how you look at it, there's a limited amount of time you can keep medical students in the classroom. And that amount of time is shortening, given the recent trends to shorten pre-clinical training and spend more time in the clinics/unstructured free time for exploring/research. Obviously a curriculum can do both - teach students about socioeconomic disparities and public health. However, we also need to recognize that at a certain point, it does become a zero sum game. Especially when you're going too far in the opposite direction. The real question is, are we spending too much time focusing on disparities that are difficult to rectify? I think there is some merit in that statement, depending on where you go to school obviously.

Doctors should obviously know about the socioeconomic determinants of health because it will help them understand their patients' circumstances and treat them better. But most doctors also aren't going to be leading systemic efforts to fix those disparities. So the question is how much required training should there be? I think there needs to be some training, but in-depth training should be left to students who are truly interested and can explore that on their elective time.

I also think that schools can do a better job of teaching how to deal with pandemics like this and how to interpret a basic epidemiological model. How many medical students can tell you what a SIR model is? Heck, how many doctors can? This stuff is important because people will ask you as a doctor about things like this even if you're not directly on the front lines of the crisis. And instead of mumbling about the symptoms and dangers, doctors should be able to be informed consumers of the medical literature. Instead of taking all of these numbers at face value, doctors need to be able to interpret them and their shortcomings. Only then can we avoid mass hysteria from media over-sensationalization of medical issues. Models are only as good as their inputs.
 
  • Like
Reactions: 13 users
Members don't see this ad :)
Someone sent me a screenshot of the article.

no. I didn’t like it. I don’t think it’s necessary that every med student spend a bunch of time on disaster preparedness and pandemic epidemiology. There are people who specialize in that and we should let them. The problem of docs going on tv and spouting crap they don’t understand is not a flaw in med school curriculum but in human hubris

As to references to the social disparity stuff, I think it is reasonable to a point. I think it fair to understand the likelihood someone can’t afford tresiba or have a carto drive to a real grocery store so that you can anticipate teaching walmart insulin and diet counseling. I don’t think it is appropriate for med schools to teach the (often included assumption)notion that docs should be pushing for particular social welfare programs. That is politics, not medicine. Med schools should teach medicine
 
Last edited by a moderator:
  • Like
  • Love
  • Wow
Reactions: 11 users
Didn't this guy write something similar like 8 months ago? I've read parts of it. He mostly says things that aren't that offensive or controversial but could be if you interpret his argument in the least gratuitous way possible to the point of being dishonest. Naturally, dumb progressives on twitter take the bait and do exactly that. Then people who are right on the political scale of tankie might argue in against interpreting it that way and. Then people flame each other and accuse everyone else of being a bad doctor/person. Discourse in 2020.

He just says random stuff with no substance, he never actually says anything in these articles. This time he's just using the hot button issue of the day to garner attention. He doesn't even put forth any evidence to show that the addition of "social justice" causes to the medical school curriculum is causing students to not learn medicine. From the article:

Most medical schools don’t require students to do coursework on pandemic response or practical preparation for a widespread and sustained emergency.

What does such preparation even look like? When has something like this happened before? They're going to medical school to treat disease, doctors are treating the disease. People are staying home. It was a public policy problem, not a doctors not knowing what to do problem. There wasn't enough PPE, vents, etc our government.... is being run by a reality star. An extra two weeks in emergency medicine isn't going to mean someone who's been practicing a s a psychiatrist for 20 years is ready to go to the ER when a pandemic hits.

While medical schools require students to study statistics, these courses are generally superficial. They wouldn’t equip most physicians to grapple with epidemic models like the ones on which Deborah Birx has been briefing the White House press.

Yeah, most people aren't briefing the white house though. A lot of med students stepped up to the plate and actually did useful things like gathering PPE donations, tutoring kids in their online courses, and buying groceries for elderly people who would be most at risk. Most of the graduates were doing... ya know... doctor stuff. Also really? Does adding another week of epidemiology to the medical school curriculum constitute an overhaul? That's like not even worthy of an announcement, you could just slap that in and nobody would notice or care.

0/10 Wall Street Journal level health journalism.
 
  • Like
  • Love
Reactions: 5 users
Wasn't he the same person who suggested cutting out social justice issues from the medical curriculum entirely?
:excuseme: -Yikes-
That would be a great idea. Politics and religion should play minimal/no role in a scientific education. Especially one that costs up to $100K/year.

There should be a Hatch Act for education.
 
Last edited by a moderator:
  • Like
  • Haha
Reactions: 7 users
That would be a great idea. Politics and religion should play minimal/no role in a scientific education. Especially one that costs up to $100K/year.

There should be a Hatch Act for education.
I'm pretty sure an understanding of different models of healthcare systems (something inherently political) and how different laws, policies, and social factors can affect patients/health outcomes is incredibly valuable and should be an integral part of a scientific/medical education.

In fact, I would not want to pay $100K/year for one that was incomplete because the designers chose to ignore political issues.
 
  • Like
Reactions: 6 users
I'm pretty sure an understanding of different models of healthcare systems (something inherently political) and how different laws, policies, and social factors can affect patients/health outcomes is incredibly valuable and should be an integral part of a scientific/medical education.

In fact, I would not want to pay $100K/year for one that was incomplete because the designers chose to ignore political issues.
Not our job. We do medicine, not design society
 
  • Like
  • Dislike
  • Love
Reactions: 6 users
Not our job. We do medicine, not design society

Attitudes like this are a big part of why these disparities still exist in medicine. Pretending societal issues are outside the scope of medical practice is factually incorrect and detrimental to patients. We may not "design society", but we have voices to which people will listen and it's our job to improve the lives of our patients. Prescriptions aren't the only tools we have as physicians to do that.

EDIT: To add, I'm not really sure what one group of people "designs society". We as citizens of the country and the world all play a role in creating the world around us. I don't understand how doctors are any different and why we shouldn't use our point of view and knowledge to help create the best society for those around us.
 
  • Like
  • Love
  • Okay...
Reactions: 25 users
Attitudes like this are a big part of why these disparities still exist in medicine. Pretending societal issues are outside the scope of medical practice is factually incorrect and detrimental to patients. We may not "design society", but we have voices to which people will listen and it's our job to improve the lives of our patients. Prescriptions aren't the only tools we have as physicians to do that.

EDIT: To add, I'm not really sure what one group of people "designs society". We as citizens of the country and the world all play a role in creating the world around us. I don't understand how doctors are any different and why we shouldn't use our point of view and knowledge to help create the best society for those around us.
You do your political crap on your own time. To try and wrap up your on personal political agenda in the prestige of a white coat does nothing but dilute the actual trust of the physician. The physician is there to do medicine. Med school is there to train physicians. If you want a ton of training in economics, sociology, health management etc, go get degrees in those things

To go further, societal disparities aren't our job either. That's a snuck premise which comes from this attempt to mix politics and medicine.
 
  • Like
  • Dislike
  • Love
Reactions: 14 users
You do your political crap on your own time. To try and wrap up your on personal political agenda in the prestige of a white coat does nothing but dilute the actual trust of the physician. The physician is there to do medicine. Med school is there to train physicians. If you want a ton of training in economics, sociology, health management etc, go get degrees in those things

To go further, societal disparities aren't our job either. That's a snuck premise which comes from this attempt to mix politics and medicine.

Well, HHS disagrees.

Also, I don't want a "ton of training in economics, sociology, health management etc". I want to learn what I need to do in order to be the best physician possible in all aspects for my patients. Luckily, the school I will be attending (along with essentially every other med school in the country nowadays) agrees that these factors are important.

I'm glad you feel comfortable taking the easy way out by saying that the most difficult issues in our country to solve aren't your job. Some people don't have the luxury of just pretending these issues don't exist because they affect them on a daily basis.
 
  • Like
  • Okay...
Reactions: 6 users
I think every student should have a longitudinal "capstone" project about the social determinants of health. It makes us better and more well rounded providers.

Also we should fight for equal pay. Its ridiculous that our "supervising" physicians make way more than us NPs.

Oh wait.

Wrong thread.

/s

On a serious note how much of the curriculum do you really need to devote to this? 90% of social health differences can be explained quite simply.

Poor people have less money. With less money its harder to eat healthy. Less healthy foods leads to obesity, DM, HTN, etc. Less access to healthcare due to insurance status or job (hard to make a PCP appointment with no PTO or sick leave) means health problems fester until you have a full blown stroke or MI. Then you cant work and are disabled. You might not qualify for disability based on your immigration status/lack of paperwork. Your family was dependent on you and now is homeless. Your kids suffer psychological consequences as a result and are traumatized. etc. etc. etc.

As an individual physician you can only do a few things for these people.
1) understand the resources that they can have access to (of course a social worker knows even more)
2) try to consolidate appointments or do as much as possible over the phone to ensure the patient has as few co-pays as possible. Of course this requires insurance companies, including Medicaid, to actually reimburse you for all that.
3) don't rx super expensive meds. Prescribe the cheap insulin. Prescribe meds on the $5 walmart list. Consolidate meds. Does the patient need 2 different HTN drugs or can they get away with a higher dose of just 1?

Every graduating medical student knows these things already.

Beyond those kinds of things what else do you expect physicians to do? Hold patient's hands and sing kumbaya? Walk with them to the grocery store and literally pick out healthier options?

Not to mention discussion of the social determinants of health almost always has a political bent.
But there are a few topics that are just too taboo to talk about. The ones that make everyone in the room, uncomfortable.

Nobody asks why the divorce rate among the poor is substantially higher than that of the wealthy (including physicians). Being poor =/= divorce after all. This was not always the case historically. Families stuck together. Broken families have a number of problems at a higher rate than intact families. Higher rates of child abuse, for example.

But nobody would dare say that openly during a med school discussion. Can you imagine the response? Good chance you'd have a meeting with the dean after someone complains. You might even be docked for "Professionalism". Why? Because any thought that some of the social determinants of health might be, even marginally, in part due to the behaviors of the people themselves is just left off the table from the beginning.


EDIT: as a side note for the PCPs who rail on about this stuff. You know what you could do? Maybe expand clinic hours at least a couple days a week or increase weekend availability so that poor patients can actually find time to go to their appointments around their jobs. You can't just rail on about access to healthcare while working bankers hours as an attending...
 
  • Like
  • Wow
  • Haha
Reactions: 11 users
Well, HHS disagrees.

Also, I don't want a "ton of training in economics, sociology, health management etc". I want to learn what I need to do in order to be the best physician possible in all aspects for my patients. Luckily, the school I will be attending (along with essentially every other med school in the country nowadays) agrees that these factors are important.

I'm glad you feel comfortable taking the easy way out by saying that the most difficult issues in our country to solve aren't your job. Some people don't have the luxury of just pretending these issues don't exist because they affect them on a daily basis.
HHS is political, I don’t care what they think about this topic.
 
  • Like
Reactions: 1 user
I think every student should have a longitudinal "capstone" project about the social determinants of health. It makes us better and more well rounded providers.

Also we should fight for equal pay. Its ridiculous that our "supervising" physicians make way more than us NPs.

Oh wait.

Wrong thread.

/s

On a serious note how much of the curriculum do you really need to devote to this? 90% of social health differences can be explained quite simply.

Poor people have less money. With less money its harder to eat healthy. Less healthy foods leads to obesity, DM, HTN, etc. Less access to healthcare due to insurance status or job (hard to make a PCP appointment with no PTO or sick leave) means health problems fester until you have a full blown stroke or MI. Then you cant work and are disabled. You might not qualify for disability based on your immigration status/lack of paperwork. Your family was dependent on you and now is homeless. Your kids suffer psychological consequences as a result and are traumatized. etc. etc. etc.

As an individual physician you can only do a few things for these people.
1) understand the resources that they can have access to (of course a social worker knows even more)
2) try to consolidate appointments or do as much as possible over the phone to ensure the patient has as few co-pays as possible. Of course this requires insurance companies, including Medicaid, to actually reimburse you for all that.
3) don't rx super expensive meds. Prescribe the cheap insulin. Prescribe meds on the $5 walmart list. Consolidate meds. Does the patient need 2 different HTN drugs or can they get away with a higher dose of just 1?

Every graduating medical student knows these things already.

Beyond those kinds of things what else do you expect physicians to do? Hold patient's hands and sing kumbaya? Walk with them to the grocery store and literally pick out healthier options?

Not to mention discussion of the social determinants of health almost always has a political bent.
But there are a few topics that are just too taboo to talk about. The ones that make everyone in the room, uncomfortable.

Nobody asks why the divorce rate among the poor is substantially higher than that of the wealthy (including physicians). Being poor =/= divorce after all. This was not always the case historically. Families stuck together. Broken families have a number of problems at a higher rate than intact families. Higher rates of child abuse, for example.

But nobody would dare say that openly during a med school discussion. Can you imagine the response? Good chance you'd have a meeting with the dean after someone complains. You might even be docked for "Professionalism". Why? Because any thought that some of the social determinants of health might be, even marginally, in part due to the behaviors of the people themselves is just left off the table from the beginning.


EDIT: as a side note for the PCPs who rail on about this stuff. You know what you could do? Maybe expand clinic hours at least a couple days a week or increase weekend availability so that poor patients can actually find time to go to their appointments around their jobs. You can't just rail on about access to healthcare while working bankers hours as an attending...

Thank you for actually steel-manning the argument. To add to this and address some of the previous comments: sure, gaining an awareness of the social determinants of health through coursework may position future physicians to be better-equipped social justice advocates (even though the vast majority of physicians will not spend their time doing so), however beyond this, it is difficult to imagine how a physician can impact disparities when policy makers have a hard enough time. As is suggested above, the hard truth is that disparities arise from differences in individual behavior, environment, culture, and yes, in some cases (but probably not a significant plurality) malignant outside actors, between groups. There is just no way that physicians can have any really substantial impact, and thus, it is argued (though an unnecessary dichotomy is set up) that the time for such courses should be reallocated to something that is directly related to medicine, after all, we are paying hundreds of thousands to learn clinical skills. I can learn about the social determinants of health on Pubmed for free. In fact, as future physicians and lifetime learners, we should not need to reallocate valuable lecture time to something that could be so easily explored in every medical students free time.

I guess my point is that we should only be learning things that will provide us with skills or understnding that allow us to directly solve the problems we will see as physicians. You truly don't need a full on course to understand and be sympathetic to someone's personal circumstances and to strategize with those individuals, especially when these courses tend to be so politically one-sided and not truly address many of the causes of such disparities (as alluded to above). If we want to learn about things that are only tangentially related to the work that the vast majority of us will actually be doing, why stop with SDH courses?

Disclaimer: I have great interest in SDH and understanding the causes of disparities. I am writing the above because I think that it is important that both sides of an argument are fairly and strongly presented. Although the article was wrong to imply that SDH courses and epidemiology courses were mutually exclusive in a curriculum, I think the essence of the article is correct but was frivolously addressed by some of the early posters in this thread. And yes, the author does come off as a bit crass in his presentation given the climate, but I do think that he is essentially correct. We are life-long learners, and thus the onus should fall on us to learn things that are only tangentially related to issues in our purview in our free time, while allowing me to pay for what I can't obtain elsewhere: clinical skills and knowledge
 
  • Like
  • Wow
Reactions: 3 users
Same answer. The people in charge started to use their influence within medicine to push their own political agendas. Medicine should be apolitical
I understand that I am not going to change your opinion that sociopolitical issues don't belong in medicine, but I don't think it is fair to dismiss the evidence from widely respected governing bodies and the huge body of research showing the importance of these issues in medicine. There is a reason beyond the views of a select few people running these organizations that these issues are included in medical school curricula, and many people like myself are glad they are part of the curriculum.
 
  • Like
Reactions: 2 users
Ah yes but you see when someone sees something they view as a problem, everyone and their mother have to pitch in to solve it whether if they agree or not.

PCPs can do whatever they want. I mention them because they seem to the most vocal social justice warriors. On the other hand I've never heard an orthopedic surgeon utter those words.

The more time you spend doing tasks that other non-physicians can do the LESS you can justify increasing your pay.
You don't need a physician for many of these things.

New diabetic that needs insulin. The physicians job IMO is to make the diagnosis, ensure that insulin is actually needed and make sure the patient understands any indications and contraindications. Those are the parts that you went to medical school for.

The diabetic educator is the one that actually spends time showing the patient how to use their insulin needles and how to properly administer the correct dose. The physician's job is to determine the dose.

Just like the asthma coordinator actually shows the patient how to use the inhaler since that is more time consuming and is an inefficient use of their time.

The more you want primary care docs to act as patient advocates rather than physicians the more you do to actually strengthen midlevel's arguments that primary care can be done by them.
 
  • Like
Reactions: 3 users
Same answer. The people in charge started to use their influence within medicine to push their own political agendas. Medicine should be apolitical
Totally agree with you. I have a question for you which I also have difficulty answering. What if knowing and dealing politics could save more lives? is it every doctor’s goal that saves as many as possible?
 
PCPs can do whatever they want. I mention them because they seem to the most vocal social justice warriors. On the other hand I've never heard an orthopedic surgeon utter those words.

The more time you spend doing tasks that other non-physicians can do the LESS you can justify increasing your pay.
You don't need a physician for many of these things.

New diabetic that needs insulin. The physicians job IMO is to make the diagnosis, ensure that insulin is actually needed and make sure the patient understands any indications and contraindications. Those are the parts that you went to medical school for.

The diabetic educator is the one that actually spends time showing the patient how to use their insulin needles and how to properly administer the correct dose. The physician's job is to determine the dose.

Just like the asthma coordinator actually shows the patient how to use the inhaler since that is more time consuming and is an inefficient use of their time.

The more you want primary care docs to act as patient advocates rather than physicians the more you do to actually strengthen midlevel's arguments that primary care can be done by them.

I agree with you. I was being sarcastic.

There is a reason beyond the views of a select few people running these organizations that these issues are included in medical school curricula, and many people like myself are glad they are part of the curriculum.

In other news you don't listen much outside your own bubble.
 
  • Like
  • Haha
Reactions: 3 users
In other news you don't listen much outside your own bubble.
I guess my bubble just happens to include HHS, AMA, ACGME, and AAMC.

EDIT: I totally get that you (and I’m sure plenty of other people) disagree with my point of view. That doesn’t mean that my viewpoint is narrow or invalid.
 
Last edited:
I understand that I am not going to change your opinion that sociopolitical issues don't belong in medicine, but I don't think it is fair to dismiss the evidence from widely respected governing bodies and the huge body of research showing the importance of these issues in medicine. There is a reason beyond the views of a select few people running these organizations that these issues are included in medical school curricula, and many people like myself are glad they are part of the curriculum.
I’m not dismissing that govt policy can impact people, I’m saying that doesn’t mean it belongs in medical education
 
  • Like
  • Love
Reactions: 1 users
PCPs can do whatever they want. I mention them because they seem to the most vocal social justice warriors. On the other hand I've never heard an orthopedic surgeon utter those words.

The more time you spend doing tasks that other non-physicians can do the LESS you can justify increasing your pay.
You don't need a physician for many of these things.

New diabetic that needs insulin. The physicians job IMO is to make the diagnosis, ensure that insulin is actually needed and make sure the patient understands any indications and contraindications. Those are the parts that you went to medical school for.

The diabetic educator is the one that actually spends time showing the patient how to use their insulin needles and how to properly administer the correct dose. The physician's job is to determine the dose.

Just like the asthma coordinator actually shows the patient how to use the inhaler since that is more time consuming and is an inefficient use of their time.

The more you want primary care docs to act as patient advocates rather than physicians the more you do to actually strengthen midlevel's arguments that primary care can be done by them.

When I was shadowing, I had an orthopedic surgeon lecture me the entire length of a surgery about how he approached this particular surgery differently than a normal one, because he was working on a prison patient. He explained in great detail the disparities facing the prisoner while recovering from the surgery, how prison patients are at higher risk for post-op infection, how the surgery and recovery might affect how the patient interacted with the rest of the prison population, how it might make him a victim of violent crime due to being seen as a 'weakness' later on. He was concerned about the patient not getting the same level of post-op care that a non-incarcerated patient would get, and what kind of effect that might have later down the road. I'm not sure if he was taught any of this in medical school, or just observed through working with underserved populations for years and made adjustments as he went, but I was definitely impressed by him.

I do think there is a place to teach social disparities, especially because medical schools tend to be filled with priveledged students who have never seen them, but I think clinical opportunities, community service, etc. might be better than teaching them in a lecture hall. I do think it's the job of a doctor to educate their patient, work within the patient's limitations, and go the extra mile to make an insurance call, but I don't think that should be done to the exclusion of practicing medicine. That role could be filled by social workers. The role that the WSJ author is proposing should be filled by MPH graduates...that's why the MPH degree exists.
 
  • Like
  • Love
Reactions: 16 users
Totally agree with you. I have a question for you which I also have difficulty answering. What if knowing and dealing politics could save more lives? is it every doctor’s goal that saves as many as possible?
Not through politics. Not our jurisdiction as a profession. Do that on your own time
 
Not our job. We do medicine, not design society

It's not about designing society, it's about getting students to think more critically about things. When you think more critically about stuff, you might change your behavior, your attitudes, and that matters. To think about how they run their practice, what treatments they recommend, how patient's social lives affect them and how they can do better.

Nobody is trying to indoctrinate medical students into becoming political activists. Sure it seems like political preaching, but politics effects healthcare outcomes. There's nothing wrong with talking about it. If X party's policy lead to Y outcome, it's not a political statement; it's just an objective analysis of what happened. It's not just political, ultimately you're going to find yourself making policy decisions that matter and could effect people negatively in ways you didn't intend and wouldn't be comfortable with.

A lot of the bad policy decisions happen because people made a policy to solve some type of problem but did it in a way that had effects they didn't want or intend. If you open a practice and don't accept medicaid, what are the consequences? If you knew that you could afford to take the hit and people wouldn't have to wait forever to see someone 2 hours away would you do it? How do your office hours affect people's access to care? Is there something you could do differently that helps people and works for you? It's about getting students to think about these questions, not cramming the answers down their throat.
 
  • Like
  • Love
Reactions: 5 users
When I was shadowing, I had an orthopedic surgeon lecture me the entire length of a surgery about how he approached this particular surgery differently than a normal one, because he was working on a prison patient. He explained in great detail the disparities facing the prisoner while recovering from the surgery, how prison patients are at higher risk for post-op infection, how the surgery and recovery might affect how the patient interacted with the rest of the prison population, how it might make him a victim of violent crime due to being seen as a 'weakness' later on. He was concerned about the patient not getting the same level of post-op care that a non-incarcerated patient would get, and what kind of effect that might have later down the road. I'm not sure if he was taught any of this in medical school, or just observed through working with underserved populations for years and made adjustments as he went, but I was definitely impressed by him.

I do think there is a place to teach social disparities, especially because medical schools tend to be filled with priveledged students who have never seen them, but I think clinical opportunities, community service, etc. might be better than teaching them in a lecture hall. I do think it's the job of a doctor to educate their patient, work within the patient's limitations, and go the extra mile to make an insurance call, but I don't think that should be done to the exclusion of practicing medicine. That role could be filled by social workers. The role that the WSJ author is proposing should be filled by MPH graduates...that's why the MPH degree exists.

Yes and this is fine. Just as my IR attendings taking into account that poor patients are more likely to get a PleurX catheter infected and therefore it was better to just have them come back for intermittent thoracentesis.

This doesn't take long to teach. Probably 2 days worth of lectures max.

The people that are gung-ho in promoting this though want a hell of a lot more than that though which is completely unnecessary.
 
  • Like
Reactions: 5 users
Nobody is trying to indoctrinate medical students into becoming political activists.

I strongly disagree based upon what is taught at the coastal/metropolitan med schools. However, those schools may just attract those types as well.
 
  • Like
Reactions: 8 users
It's not about designing society, it's about getting students to think more critically about things. When you think more critically about stuff, you might change your behavior, your attitudes, and that matters. To think about how they run their practice, what treatments they recommend, how patient's social lives affect them and how they can do better.

Nobody is trying to indoctrinate medical students into becoming political activists. Sure it seems like political preaching, but politics effects healthcare outcomes. There's nothing wrong with talking about it. If X party's policy lead to Y outcome, it's not a political statement; it's just an objective analysis of what happened. It's not just political, ultimately you're going to find yourself making policy decisions that matter and could effect people negatively in ways you didn't intend and wouldn't be comfortable with.

A lot of the bad policy decisions happen because people made a policy to solve some type of problem but did it in a way that had effects they didn't want or intend. If you open a practice and don't accept medicaid, what are the consequences? If you knew that you could afford to take the hit and people wouldn't have to wait forever to see someone 2 hours away would you do it? How do your office hours affect people's access to care? Is there something you could do differently that helps people and works for you? It's about getting students to think about these questions, not cramming the answers down their throat.
Some of your examples are about navigating current policy/billing which is appropriate but what usually happens in these sessions is a push to advocacy of policy. That’s inappropriate and out of medical jurisdiction
 
  • Like
  • Dislike
Reactions: 3 users
Not our job. We do medicine, not design society

Can you elaborate on this statement?

Isn't that one of the problems with modern medicine? Physicians didn't care enough about the "not-medicine" stuff, so now we follow rules designed by MBAs and other useless administrators?
 
  • Like
Reactions: 1 user
Can you elaborate on this statement?

Isn't that one of the problems with modern medicine? Physicians didn't care enough about the "not-medicine" stuff, so now we follow rules designed by MBAs and other useless administrators?
There is a difference between doctors telling administrators to stay out of medical decision making and trying to pitch the doctors need to be making public policy advocacy part of their role (no they shouldn’t)
 
  • Like
Reactions: 2 users
There is a difference between doctors telling administrators to stay out of medical decision making and trying to pitch the doctors need to be making public policy advocacy part of their role (no they shouldn’t)

Is this actually happening in medical schools to any appreciable degree?

I'm sure there are doctors who believe this (there are doctors for every belief out there), but I haven't found this to be a mainstream belief in faculty members.
 
no. I didn’t like it. I don’t think it’s necessary that every med student spend a bunch of time on disaster preparedness and pandemic epidemiology. There are people who specialize in that and we should let them. The problem of docs going on tv and spouting crap they don’t understand is not a flaw in med school curriculum but in human hubris
Not our job. We do medicine, not design society

Understanding epidemiology isn't designing society. It's about understanding how to best help your patients. Why are you going to tell your patients to wash their hands after interacting with other people? Because you understand how respiratory viruses spread. Smallpox was eradicated due to the concerted efforts of doctors, epidemiologists, and other allied health professionals who understood how it spread and what it would take to eradicate it. Doctors are uniquely positioned with their medical training to be able to provide insight into these disciplines and to be able to interpret these key findings in terms of what it means for patients. They should understand these principles at a basic level in order to be able to interpret things for their patients. Same reason why doctors need to understand how statistics works in the setting of being able to interpret studies into clinical practice. Otherwise you get the Wakefield problem.
 
  • Like
Reactions: 1 users
Some of your examples are about navigating current policy/billing which is appropriate but what usually happens in these sessions is a push to advocacy of policy. That’s inappropriate and out of medical jurisdiction
I think that's because medicine has one easy yardstick: do what's best for the patient's health. During these sessions, it usually becomes pretty obvious that certain policies are not very conducive for that, and that patients' health would be improved if those changed.
 
  • Like
Reactions: 1 user
Same answer. The people in charge started to use their influence within medicine to push their own political agendas. Medicine should be apolitical
So physicians should shut up about the obvious injustices in health care delivery and access in order to not risk being “political”? If your mothers, sisters, and daughters were dying at more than double the rate of white women as a result of childbirth, you probably would not give a damn about appearing political. If you were raising kids with asthma near a highway, lower emissions standards is not an academic discussion between the honorable gentleman from Oklahoma and the honorable gentleman from New York. It’s life or death. No one said it’s only on physicians’ shoulders to reach health equity. It is our responsibility to learn about it, we’re the ones administering goddamn the care. Should we not learn about genetic diseases to which there are no cures because we can’t solve the problem? Who else is going to advocate for our patients? Politicians? Only lazy people voluntarily narrow the scope and education of their chosen profession. Healthcare providers should not be ignorant on healthcare issues/ solutions.
 
  • Like
  • Okay...
Reactions: 19 users
So physicians should shut up about the obvious injustices in health care delivery and access in order to not risk being “political”? If your mothers, sisters, and daughters were dying at more than double the rate of white women as a result of childbirth, you probably would not give a damn about appearing political. If you were raising kids with asthma near a highway, lower emissions standards is not an academic discussion between the honorable gentleman from Oklahoma and the honorable gentleman from New York. It’s life or death. No one said it’s only on physicians’ shoulders to reach health equity. It is our responsibility to learn about it, we’re the ones administering goddamn the care. Should we not learn about genetic diseases to which there are no cures because we can’t solve the problem? Who else is going to advocate for our patients? Politicians? Only lazy people voluntarily narrow the scope and education of their chosen profession. Healthcare providers should not be ignorant on healthcare issues/ solutions.

Did you just purposely miss the point or was this an unintentional straw man? You can advocate all you want, but schools shouldn’t be force feeding this crap when the curriculum is saturated enough. And this has been beaten to death already and pointed out already. Poor people have it worse. Boohoo so what.
 
  • Inappropriate
  • Like
Reactions: 1 users
As a side note to this thread that I will immediately go and unwatch: Not everything regarding race, gender, wealth, sexuality, environment etc. is "political", but calling it politics is a great way to dismiss the many intersecting and inseparable ways that factors outside the narrow definition of medicine that some have impact health.
 
  • Like
  • Okay...
Reactions: 16 users
Is this actually happening in medical schools to any appreciable degree?

I'm sure there are doctors who believe this (there are doctors for every belief out there), but I haven't found this to be a mainstream belief in faculty members.
Yes, I am saying this is happening in med schools and in the specialty societies as well as the ama
 
  • Like
Reactions: 1 users
I think that's because medicine has one easy yardstick: do what's best for the patient's health. During these sessions, it usually becomes pretty obvious that certain policies are not very conducive for that, and that patients' health would be improved if those changed.
It is medicine to announce that a patient would be healthier if they chose to eat a certain way

it is politics to announce a new tax, subsidy or ban designed to enforce that eating

one of those is a role for doctors
 
  • Like
Reactions: 2 users
Top