WSJ article: "Med School Needs an Overhaul"

[deleted480308]

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.

You are extrapolating things I didn’t say. If you want to discuss a specific thing, ask it.

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[finn_]

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

I take issue with telling any group of people to "stay in their lane." Doctors are in fact some of the best people to work on policy around health issues (ex. gun violence) because they see the issues and their consequences on a daily basis (akin to one reason why so many people do MD/PhDs—the clinic work helps inform the research). Of course not every doctor has to engage in policy work (I personally don't think it will be a focus of my career, I'm a computational scientist), but it is well within one's role as a doctor.

 

[deleted480308]

I take issue with telling any group of people to "stay in their lane." Doctors are in fact some of the best people to work on policy around health issues (ex. gun violence) because they see the issues and their consequences on a daily basis (akin to one reason why so many people do MD/PhDs—the clinic work helps inform the research). Of course not every doctor has to engage in policy work (I personally don't think it will be a focus of my career, I'm a computational scientist), but it is well within one's role as a doctor.

It really isn’t. I read the 6 specialty statement on gun policy and it was clear they don’t actually know much about guns. What to do when someone gets shot is a doctor’s job. Gun policy is not a doctor’s job any more than it’s a doctor’s job to decide how big a dr pepper you are allowed to buy

 

[Mkif586]

This is a great example of a whole bunch of cognitive distortions:

Doctors are in fact some of the best people to work on policy around health issues

Health issue: poor people have more health complications and live shorter lives. Let's give doctors exciting opportunity to design new minimum wage reform.
"The illusion of control" which is the tendency of people to believe that they can control, or at least influence the outcome of events that they really cannot influence. Studies show that general public has little to no impact on creating new policies, while "the rich boys club" has very high impact.
"The Dunning - Krueger effect" - people with a low level of qualification make erroneous conclusions (oh yeah, being a dermatologist is a great expertise to make laws, though personally I trust any dermatologist way more than all congressmen combined but this is halo effect), make unsuccessful decisions, and at the same time are unable to recognize their mistakes due to the low level of their qualifications.

(ex. gun violence) because they see the issues and their consequences on a daily basis

Generalization of special cases or overgeneralizing. Imagine you work in ER in some busy area. You see 2-3 gun shots every week. You begin assuming that the whole country is messed up and bangunsnowstupididiots. The argument that "if we ban all guns we will save some lives". Great argument but... "The effect of pseudo-confidence" which is the tendency to make decisions aimed at avoiding risk if the expected result is positive. The truth is we already have more guns than people out there, in todays America banning weapons is like banning screwdrivers, in fact, it will leave people helpless in from of criminals who already have guns. By saving people from mass shootings you don't know how many will be killed because they don't have weapons to protect them now. But this topic is for spf forum. Besides, what can be done to reduce gun violence? Ban weapons - not going to work. Teach people that killing each other is bad? – good luck with that.

 

[finn_]

This is a great example of a whole bunch of cognitive distortions:

Health issue: poor people have more health complications and live shorter lives. Let's give doctors exciting opportunity to design new minimum wage reform.
"The illusion of control" which is the tendency of people to believe that they can control, or at least influence the outcome of events that they really cannot influence. Studies show that general public have little to know impact on creating new policies, while "the rich boys club" have very high impact.
"The Dunning - Krueger effect" - people with a low level of qualification make erroneous conclusions (oh yeah, being a dermatologist is a great expertise to make laws, though personally I trust any dermatologist way more than all congressmen combined but this is halo effect), make unsuccessful decisions, and at the same time are unable to recognize their mistakes due to the low level of their qualifications.


Generalization of special cases or overgeneralizing. Imagine you work in ER in some busy area. You see 2-3 gun shots every week. You begin assuming that the whole country is messed up and bungunsnowstupididiots. The argument that "if we ban all guns we will save some lives". Great argument but... "The effect of pseudo-confidence" which is the tendency to make decisions aimed at avoiding risk if the expected result is positive. The truth is we already have more guns than people out there, in todays America banning weapons is like banning screwdrivers, in fact, it will leave people helpless in from of criminals who already have guns. By saving people from mass shootings you don't know how many will be killed because they don't have weapons to protect them now. But this topic is for spf forum.

Wow, you put a lot of words in my mouth!

I did not say "doctors should design all new laws/policies in areas unrelated to medicine". I said that doctors should be trained/free to work in health policy, particularly with respect to issues that directly affect care.

I also did not say anywhere that we should ban guns. I said that doctors who see firsthand the effects of gun violence would provide a valuable perspective on gun violence when developing gun violence legislation.

 

[deleted480308]

Wow, you put a lot of words in my mouth!

I did not say "doctors should design all new laws/policies in areas unrelated to medicine". I said that doctors should be trained/free to work in health policy, particularly with respect to issues that directly affect care.

I also did not say anywhere that we should ban guns. I said that doctors who see firsthand the effects of gun violence would provide a valuable perspective on gun violence when developing gun violence legislation.

Doctors do not have a valuable perspective on guns. Everyone knows guns can kill people.

 

[Mkif586]

I said that doctors who see firsthand the effects of gun violence would provide a valuable perspective on gun violence when developing gun violence legislation.

They will not. What valuable perspective do they have?

Doctors do not have a valuable perspective on guns. Everyone knows guns can kill people.

Saying guns kill people is like saying spoons make people fat. People kill people, period.

 

[Mkif586]

So physicians should shut up about the obvious injustices in health care delivery and access in order to not risk being “political”?

Will be very thankful for at least one single example throughout the past 20-30 years when some group of doctors was like "hey folks in congress we have a problem here" and people in congress successfully passed a new law to improve the situation. Just one example please.

 

[ginsengreset]

Doctors do not have a valuable perspective on guns. Everyone knows guns can kill people.

Yes, guns kill people. But guns also leave people paralyzed and needing medical care for the rest of their lives. A gunshot wound that kills someone can be preceded by hours or days of intensive medical care to address massive internal organ damage due to hollow-point AR bullets. Who else would provide this perspective?

There's this piece by an EM attending and the public health commissioner of Baltimore, which I found summarizes this view pretty well: Opinion | What Bullets Do to Bodies

 

[Mkif586]

Yes, guns kill people.

Same with swords, arrows, knifes, gas explosions, didn't society have huge amount of murders way before gunpowder was invented?

But guns also leave people paralyzed and needing medical care for the rest of their lives. A gunshot wound that kills someone can be preceded by hours or days of intensive medical care to address massive internal organ damage due to hollow-point AR bullets. Who else would provide this perspective?

Anyone older than 7?

 

[finn_]

Doctors do not have a valuable perspective on guns. Everyone knows guns can kill people.

They will not. What valuable perspective do they have?

Saying guns kill people is like saying spoons make people fat. People kill people, period.

I think the clearest example would be psychiatrists using their experience with treating mental health issues to elucidate in which ways mental health care can be improved to reduce gun violence.

This is also a good resource: Center for Gun Violence Prevention

In addition to their perspective, physicians (according to the AMA's Code of Medical Ethics) “have an ethical responsibility to seek change when they believe the requirements of law or policy are contrary to the best interests of patients.”

Will be very thankful for at least one single example throughout the past 20-30 years when some group of doctors was like "hey folks in congress we have a problem here" and people in congress successfully passed a new law to improve the situation. Just one example please.

How physician advocacy shaped health care in 2016

The physician voice was heard, leaving its mark on changes to the health care system and protecting patients this year.

www.ama-assn.org

But I think another great example is the current situation around COVID-19:

COVID-19: Advocacy Progress Report

View the AMA's progress report on the advocacy actions taken to help affect change during the COVID-19 outbreak.

www.ama-assn.org

 

[ginsengreset]

Same with swords, arrows, knifes, gas explosions, didn't society have huge amount of murders way before gunpowder was invented?

Yes, a knife and a gun can both kill someone, in the same way overdosing on acetaminophen and overdosing on oxycodone can both kill someone. But one is a schedule II controlled substance and the other is not, and you know that's because one has a much higher potential for harm

 

[deleted480308]

Yes, guns kill people. But guns also leave people paralyzed and needing medical care for the rest of their lives. A gunshot wound that kills someone can be preceded by hours or days of intensive medical care to address massive internal organ damage due to hollow-point AR bullets. Who else would provide this perspective?

There's this piece by an EM attending and the public health commissioner of Baltimore, which I found summarizes this view pretty well: Opinion | What Bullets Do to Bodies

I’ve read it. Bullets are intended to do damage. That’s the job they are supposed to do

 

[deleted480308]

I think the clearest example would be psychiatrists using their experience with treating mental health issues to elucidate in which ways mental health care can be improved to reduce gun violence.

This is also a good resource: Center for Gun Violence Prevention

In addition to their perspective, physicians (according to the AMA's Code of Medical Ethics) “have an ethical responsibility to seek change when they believe the requirements of law or policy are contrary to the best interests of patients.”

How physician advocacy shaped health care in 2016

The physician voice was heard, leaving its mark on changes to the health care system and protecting patients this year.

www.ama-assn.org

But I think another great example is the current situation around COVID-19:

COVID-19: Advocacy Progress Report

View the AMA's progress report on the advocacy actions taken to help affect change during the COVID-19 outbreak.

www.ama-assn.org

The ama is wrong. Controlling our patients via govt is wrong

 

[Mkif586]

How physician advocacy shaped health care in 2016

The physician voice was heard, leaving its mark on changes to the health care system and protecting patients this year.

www.ama-assn.org

But I think another great example is the current situation around COVID-19:

COVID-19: Advocacy Progress Report

View the AMA's progress report on the advocacy actions taken to help affect change during the COVID-19 outbreak.

www.ama-assn.org

"As a result of efforts by the AMA and other organized medicine groups". So it was done not by physicians but by AMA. Second example is also example of AMA efforts. I asked for an example of some group of ordinary doctors who influenced creating a new law that affected society in a positive way.

 

[Mkif586]

“have an ethical responsibility to seek change when they believe the requirements of law or policy are contrary to the best interests of patients.”

And you should not have sex before marriage, should never gamble, god forbid swearing, and of course you should never lie to your mom. What a great world we would live in if we did at least 10% of what we should do.

 

[Mkif586]

Yes, a knife and a gun can both kill someone, in the same way overdosing on acetaminophen and overdosing on oxycodone can both kill someone. But one is a schedule II controlled substance and the other is not, and you know that's because one has a much higher potential for harm

How does this relate to doctors training?

 

[finn_]

"As a result of efforts by the AMA and other organized medicine groups". So it was done not by physicians but by AMA. Second example is also example of AMA efforts. I asked for an example of some group of ordinary doctors who influenced creating a new law that affected society in a positive way.

If you read the letters they wrote, it's literally dozens of medical organizations writing/signing these things together. I'm not sure what counts as an "ordinary doctor" or why the dozens and dozens of doctors who belongs to the greater organizations who made these things happen "don't count". These are all examples of physicians working together to using their health knowledge and their standing in society to successfully bring about societal change they believe in.

And you should not have sex before marriage, should never gamble, god forbid swearing, and of course you should never lie to your mom. What a great world we would live in if we did at least 10% of what we should do.

Glad you agree that the world would be better if more physicians did what they were supposed to do and participated in advocacy efforts

 

[LizzyM]

Will be very thankful for at least one single example throughout the past 20-30 years when some group of doctors was like "hey folks in congress we have a problem here" and people in congress successfully passed a new law to improve the situation. Just one example please.

This relates to state laws, not federal, but the laws requiring prenatal testing for HIV were championed by physicians, were passed in some jurisdictions and have saved lives.

Is It Time to Revisit Prenatal HIV Testing Laws?

The stigma associated with HIV has diminished with its spread among the heterosexual population and the development of effective treatments. This normalization may justify assuming a more traditional public health perspective about mandatory prenatal screening.

journalofethics.ama-assn.org

 

[finn_]

The ama is wrong. Controlling our patients via govt is wrong

Well, if you think it's wrong, maybe you can engage in some advocacy efforts to get the policy changed!

 

[deleted480308]

Well, if you think it's wrong, maybe you can engage in some advocacy efforts to get the policy changed!

I can appreciate some good sarcasm. Well played

 

[Mkif586]

This relates to state laws, not federal, but the laws requiring prenatal testing for HIV were championed by physicians, were passed in some jurisdictions and have saved lives.

Is It Time to Revisit Prenatal HIV Testing Laws?

The stigma associated with HIV has diminished with its spread among the heterosexual population and the development of effective treatments. This normalization may justify assuming a more traditional public health perspective about mandatory prenatal screening.

journalofethics.ama-assn.org

"Medical professional organizations, including the American Medical Association, have decried mandatory HIV testing as a threat to patient autonomy and to the patient-doctor relationship." AMA again...
Great example! But again, survival's mistake. Of course we can say "okay, if 1 in 1000 letters that I write to AMA results in some positive change, then I should devote as much time as I can to writing letters to change the World". But life is a zero sum game, you have only 24 hours a day and only 10 fingers on your hands (well, not everyone has even that).
Now let's assume that gathering statistical information, writing and polishing letters, spending time to talk to another doctors about the issue results let's say in 20 hours of work. So one needs to spend 10 years of full time work besides the actual full time work to influence one positive change in policies. We still don't know the impact that the letter had (it could be just coincidence), and we still don't know the actual conversion rate, to be honest, I doubt it is 1 in 1000. Now we need to calculate the effectiveness of the method. What is our goal besides "make the World better and people healthier" because doctors do that every day? Most of the issues doctors facing like tremendous amount of paperwork is not a secret to anyone even those who are far from medicine. Other potential problems that nobody in the World knows besides doctor Joe from Texas? But I truly believe that if those 10 000 hours were spent improving one's knowledge about their specialty and establishing better relationships with patients it would result in a lot better outcomes at the end of the day. I do not believe that regular doctors (no, Stanford professor with MD/PhD from Harvard who is a chairman for California Medical Association is not a regular doctor) have any impact on healthcare policies, that is illusion.

 

[Mkif586]

My overall point is that:
We should not overestimate what doctors can and should do regarding policymaking. Frontline healthcare workers (not necessarily doctors btw) may have some great experience and of course see some injustice (we all know that out world is far from perfect) but it is not their job to fix it nor to investigate it further by turning into political activists; doctors may see only one aspect of a problem but don't forget that they are not sociologists, economists, and public health authorities. If you think there is an injustice – go ahead and report it, call public health department, whatever. But don't presume that because you are a doctor you now know how to fix the issue and that you even have the power to do it. Let guys on top do their job, that is why they are paid after all. Let scientists conduct a research, let politicians advocate for the issue, we have more than enough people for that, if they will ever need your perspective they will contact you. Just don't assume that because doctors see some injustice they now need to do whatever it takes to fix it. Doctors are not superheroes, they don't have the power to influence big league politics, they cannot redesign the society, and they only see one side of a problem. But don't pretend that they are as smart and capable as sociologists, economists, lawyers and now should start political campaigns. Back to the original article, I oppose mixing frontline medicine with politics. If you are smart enough to become a doctor then you are smart enough to see that some groups of people face particular challenges. But don't assume that you know everything regarding the problem, know how to fix what is outside your scope of practice, nor that you have any real power to do so. We have medical scientists, medical schools faculty and public health departments, let them do their jobs. You will do a lot better job by just seeing your patients. Again, if there is a serious issue, don't worry people already know about that, and there is nothing you personally can do to fix it.

 

[LizzyM]

People can learn how to be effective advocates and how to target their efforts to have the greatest impact. Writing letters to the AMA is not the correct strategy. Schools can teach strategy and students can get involved in causes they feel strongly about. Faculty can also teach through example as they become involved in professional organizations and patient advocacy organizations (e.g. American Cancer Society, Alzheimer's Association, etc).

 

[LizzyM]

I know of physicians who personally, not through advocacy organizations, lobbied legistlators with regard to HIV testing. You go to the state house, you appear at a hearing, you give testimony. There is an art to it and it can be taught. A doctor who has been on the front lines and who has signed death certificates etc can be a very powerful voice for change. It doesn't need to be a 100 hour course in the medical school but it can be woven into the curriculum.

 

[Mkif586]

I know of physicians who personally, not through advocacy organizations, lobbied legistlators with regard to HIV testing. You go to the state house, you appear at a hearing, you give testimony. There is an art to it and it can be taught. A doctor who has been on the front lines and who has signed death certificates etc can be a very powerful voice for change. It doesn't need to be a 100 hour course in the medical school but it can be woven into the curriculum.

If someone invites a doctor as an expert in the field (though I am 99% sure it will be some Ivy graduate) to give a testimony regarding the issue it is one thing, and there is nothing bad in it. But when doctor draws a poster and claims for “justice here and now” is a bit different. Public speaking is already taught in undergrad though. And when doctor is invited in the legislature office it means a lot of job was already done by those who are supposed to do their job. Doctor did not start that political campaign. And I doubt that that testimony made any actual impact, I still believe that laws are passed or rejected before they are even created. And we will never know how many attempts of lobbying by doctors went unsuccessful and how efficiently that time could be used instead of that. And as a classic said: because you are around politicians now don’t believe any single word you hear.

 

[deleted621740]

I know of physicians who personally, not through advocacy organizations, lobbied legistlators with regard to HIV testing. You go to the state house, you appear at a hearing, you give testimony. There is an art to it and it can be taught. A doctor who has been on the front lines and who has signed death certificates etc can be a very powerful voice for change. It doesn't need to be a 100 hour course in the medical school but it can be woven into the curriculum.

Also, I think that this is a reasonable example of how physicians could get involved given that this is legislation that offers a clear benefit to patients. If you go back earlier in the thread, the controversy was more about physicians advocating for policies that address DISPARITIES (or social determinants of health). However, because we all know that the causes of disparities are MULTIVARIATE, it will never really be in a physician's immediate purview to try to address disparities from a policy standpoint. In the example you listed, that is a bit different from legislation that would address social determinants of health/disparities because it had a clear impetus and benefit with virtually no unforseen consequences. And, physcians certainly don't need to sit through a course in medical school to see such a benefit.

Although only slightly related, I'd like to suggest Thomas Sowell's Intellectuals and Society for everyone in this thread. Although everyone's point that having a physician's perspective can be valuable in shaping policy is well taken (I'll agree, on a visceral level it does seem like this is true), I'd like to argue that it is precisely when academic step OUT of their lanes that unforseen negative consequences are manifest. Sure, physicians may have valuable anectdotes from within clinics, but the vast majority are not policy experts, and thus unforseen consequences of certain policies may arise when physicians venture beyond what they were trained for. So, if not advocating in the realm of policy, what is the need for formal coursework? Again, much of the data on social detreminants of health can be found on PubMed, and any responsible medical student should do his or her due diligence to become aware of them and keep them in mind when seeing patients.

Edited for clarity

 

[deleted621740]

I know of physicians who personally, not through advocacy organizations, lobbied legistlators with regard to HIV testing. You go to the state house, you appear at a hearing, you give testimony. There is an art to it and it can be taught. A doctor who has been on the front lines and who has signed death certificates etc can be a very powerful voice for change. It doesn't need to be a 100 hour course in the medical school but it can be woven into the curriculum.

Should it be mandatory, though? I agree that it could be beneficial for the more policy-inclined students, but would an elective opportunity not be more appropriate? Just curious on you thoughts!

 

[finn_]

Also, I think that this is a reasonable example of how physicians could get involved given that this is legislation that offers a clear benefit to patients. If you go back earlier in the thread, the controversy was more about physicians advocating for policies that address DISPARITIES (or social determinants of health). However, because we all know that the causes of disparities are MULTIVARIATE, it will never really be in a physician's immediate purview to try to address disparities from a policy standpoint. In the example you listed, that is a bit different from legislation that would address social determinants of health/disparities because it had a clear impetus and benefit with virtually no unforseen consequences. And, physcians certainly don't need to sit through a course in medical school to see such a benefit.

Although only slightly related, I'd like to suggest Thomas Sowell's Intellectuals and Society for everyone in this thread. Although everyone's point that having a physician's perspective can be valuable in shaping policy is well taken (I'll agree, on a visceral level it does seem like this is true), I'd like to argue that it is precisely when academic step OUT of their lanes that unforseen negative consequences are manifest. Sure, physicians may have valuable anectdotes from within clinics, but the vast majority are not policy experts, and thus unforseen consequences of certain policies may arise when physicians venture beyond what they were trained for. So, if not advocating in the realm of policy, what is the need for formal coursework? Again, much of the data on social detreminants of health can be found on PubMed, and any responsible medical student should do his or her due diligence to become aware of them and keep them in mind when seeing patients.

Edited for clarity

To play devil’s advocate, do you think that maybe providing these courses would help students have more informed opinions on SDH and policy and make it less likely that they are going to bring about “unforeseen negative consequences”?

 

[deleted480308]

To play devil’s advocate, do you think that maybe providing these courses would help students have more informed opinions on SDH and policy and make it less likely that they are going to bring about “unforeseen negative consequences”?

There are other degrees for that

 

[LizzyM]

There are other degrees for that

Just like there are other degrees for nutrition but we think that doctors should have a pinch of that in the curriculum, too.

 

[deleted480308]

Just like there are other degrees for nutrition but we think that doctors should have a pinch of that in the curriculum, too.

Nutrition is an actual individual level health choice, you know full well that is different from social welfare laws/advocacy even if you want both

 

[LizzyM]

Nutrition is an actual individual level health choice, you know full well that is different from social welfare laws/advocacy even if you want both

It is also biological, biochemical, related to microbiome and epigenetics. It is influenced by geograpy and culture. There are certainly economic and environmental issues related to access to safe sources of food. Advocacy around nutrition is not soley in the realm of individual level health choice -- there is a huge role for physicians concerned with, for example, how federal regulations influence what children in daycare and in schools are fed.

Physicians on the front lines can certainly provide information that influences policy. People often pick a topic they care deeply about and do what they can to influence change. It isn't always about social welfare laws. Clean, uncontaminated drinking water, food that is safe to eat, housing that is safe to live in, cars that are safe to drive... the list goes on and on.

 

[deleted621740]

To play devil’s advocate, do you think that maybe providing these courses would help students have more informed opinions on SDH and policy and make it less likely that they are going to bring about “unforeseen negative consequences”?

Well that's a good question, but let me qualify my answer to it by saying that even if I concede that it might make unintended consequences less likely, that still does not mean that it should be a mandatory element of the curriculum.

Now, do I think that it would decrease the likelihood on unintended consequences? Honestly, I don't know because I have never sat through one of these courses. I suppose it would depend on how well these courses actually explore ALL of the causes of health disparities. And quite frankly, my gut feeling is that they probably do NOT do this just because oftentimes these causes can be pretty uncomfortable to discuss, especially when emotions tend to run so high when discussing these things. But again, even if the courses were perfect, I still think that an elective opportunity would be more appropriate.

 

[communitysjw1996]

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.

I have to agree with your view, specifically that these sorts of things shouldn't be directly integrated into medical education. It would probably be ineffective to hear a 45-minute lecture about X subject related to medicine when you could read about it on the internet, do research, or pursue another degree on your own.

I mean, will we get to a point where all medical students get the equivalent of an MPH, an MBA, a JD, and a politics degree in medical school?

 

[Mkif586]

It is also biological, biochemical, related to microbiome and epigenetics. It is influenced by geograpy and culture. There are certainly economic and environmental issues related to access to safe sources of food. Advocacy around nutrition is not soley in the realm of individual level health choice -- there is a huge role for physicians concerned with, for example, how federal regulations influence what children in daycare and in schools are fed.

Physicians on the front lines can certainly provide information that influences policy. People often pick a topic they care deeply about and do what they can to influence change. It isn't always about social welfare laws. Clean, uncontaminated drinking water, food that is safe to eat, housing that is safe to live in, cars that are safe to drive... the list goes on and on.

I think we all can agree that there is some difference doctors could make. The question is how this relates to doctors scope of practice and knowledge? Advocating for better nutrition or safer cars is one thing, involving into sociopolitical issues is another. Why would medical students need to take class in social issues to advocate for better nutrition? Doctors can influence changes in diet but can’t fix social problems and should not be involved into politics that is clearly outside of medicine. If something leads to bad medical consequences it does not mean it is doctors job to fix it nor that they have enough expertise to do it. Another good example is high taxes in some areas. I deeply concerned about paying high taxes, should I now advocate for tax reform by saying it is my duty as a physician? Do I have enough expertise in economics to make sure I understand what I am talking about and that it will not lead to a economic disaster? Or if we are talking about poverty, we know that we have more than enough rich people to address the issue. As a doctor I would see that poor people have bad health, is it my time to advocate for new reform to fight poverty? Do I have enough expertise to do it? I am a doctor, not economist, saying poverty is bad does not mean I know how to fix it nor should I advocate for a particular politician who promises to fix it. I am more than sure that this class especially if taught in California will be covering only one side of the problem and will lead to a universal conclusion that capitalism is bad. And again, I don’t believe that a single doctor has enough power to influence the change.

 

[LizzyM]

A doctor can look at a group of patients and ask, why do some patients have poor outcomes? What are predictors of morbidity and mortality? Why are people of color over-represented among those with Covid 19 infections and deaths from Covid 19?

COVID-19 Health Disparities Expose Systemic Racism against African Americans

Prem Misir African American communities in the United States have always suffered health disparities compared to white Americans. COVID-19 impacts are continuing this pattern, and exposing human ri…

www.hhrjournal.org

COVID-19 Racial Health Disparities Highlight Why We Need to Address Structural Racism

COVID-19 has given us even more clarity about our society’s racial inequities.

urbn.is

This may be beyond the physician's scope of practice to address the bigger policy questions in the moment but having even a superficial understanding of the issues will help explain the phenomenon when the physician is called upon to explain the health disparity.

 

[deleted480308]

A doctor can look at a group of patients and ask, why do some patients have poor outcomes? What are predictors of morbidity and mortality? Why are people of color over-represented among those with Covid 19 infections and deaths from Covid 19?

COVID-19 Health Disparities Expose Systemic Racism against African Americans

Prem Misir African American communities in the United States have always suffered health disparities compared to white Americans. COVID-19 impacts are continuing this pattern, and exposing human ri…

www.hhrjournal.org

COVID-19 Racial Health Disparities Highlight Why We Need to Address Structural Racism

COVID-19 has given us even more clarity about our society’s racial inequities.

urbn.is

This may be beyond the physician's scope of practice to address the bigger policy questions in the moment but having even a superficial understanding of the issues will help explain the phenomenon when the physician is called upon to explain the health disparity.

That article is a great example about what I’m saying . The url literally calls the situation systemic racism. That’s a really dishonest and malicious way to describe that one group tends to have less money for expensive services. That’s not racism, that’s the fact that services cost money. In there is the snuck premise that all services should be available regardless of ability to pay. The medical institutions shouldn’t be pushing that kind of politically loaded crap, they should focus on actual medicine

 

[communitysjw1996]

I think we all can agree that there is some difference doctors could make. The question is how this relates to doctors scope of practice and knowledge? Advocating for better nutrition or safer cars is one thing, involving into sociopolitical issues is another. Why would medical students need to take class in social issues to advocate for better nutrition? Doctors can influence changes in diet but can’t fix social problems and should not be involved into politics that is clearly outside of medicine. If something leads to bad medical consequences it does not mean it is doctors job to fix it nor that they have enough expertise to do it. Another good example is high taxes in some areas. I deeply concerned about paying high taxes, should I now advocate for tax reform by saying it is my duty as a physician? Do I have enough expertise in economics to make sure I understand what I am talking about and that it will not lead to a economic disaster? Or if we are talking about poverty, we know that we have more than enough rich people to address the issue. As a doctor I would see that poor people have bad health, is it my time to advocate for new reform to fight poverty? Do I have enough expertise to do it? I am a doctor, not economist, saying poverty is bad does not mean I know how to fix it nor should I advocate for a particular politician who promises to fix it. I am more than sure that this class especially if taught in California will be covering only one side of the problem and will lead to a universal conclusion that capitalism is bad. And again, I don’t believe that a single doctor has enough power to influence the change.

I agree with your general message.

If you want physicians to influence public, social, and economic policy as a means of addressing health issues, political beliefs will probably come into play and once that happens, you might be asking for trouble, especially if you have more conservative beliefs.

 

[communitysjw1996]

That article is a great example about what I’m saying . The url literally calls the situation systemic racism. That’s a really dishonest and malicious way to describe that one group tends to have less money for expensive services. That’s not racism, that’s the fact that services cost money. In there is the snuck premise that all services should be available regardless of ability to pay. The medical institutions shouldn’t be pushing that kind of politically loaded crap, they should focus on actual medicine

I don't think you can reasonably discount racism as a contributing factor to these health disparities.

As a thought exercise, a conservative med student/physician may be more tempted to push back on the suggested root causes of these health disparities and argue that leftist/socialist progressive economic welfare policies and messaging may be at the root of the problem (e.g. economically incentivizing single minority motherhood and therefore contributing to high rates of intergenerational low income). The supposed solutions would be to be more socially, economically, and politically conservative. I believe that a medical student would feel very uncomfortable expressing these sorts of ideas when in a lecture about health disparities because that school, as most of academia, probably leans left. So, the curriculum has a good chance of being politically-skewed.

So, if you overhaul medical education to include lectures about the social/economic determinants of health disparities, you'll end up talking about things like housing, income, food security, healthcare inequality, all of which gets very political because the big solutions to these things differ based on political stance. And if you're not going to talk about the potential big solutions to these problems, is there really a purpose to the curricular addition in the first place?

Furthermore, I'm against this game of "sprinkling" medical education with all these different subjects. I mean, we need physician-leaders who understand business, so should all med students be forced to learn organizational and financial management of heathcare systems? But, you also have to learn about health disparities? Will computer science become a lecture because of the emergence of AI in medicine?

 

[Select All That Apply]

Threads like this continue to show how out of touch administrators in ivory tower settings are with the actual ground.

Putting focus on highlighting socioeconomic disparities in a lecture series is counter intuitive when the cost of debt from undergrad & medical school combined is one of the largest barriers for people who go into the profession wanting to do primary care in underserved areas for only $35 a visit. When accumulating medical school debt, it is hard to pass on that $200k salary for a 3-4 year residency although you know that EMR billing for a split nail is going to cost the patient with no insurance the equivalent of selling the arm with the nail you just patched up.

Pumping students with lectures on environmental stewardship and economic disparity from professors/academics who have clearly never had experienced frictional homelessness in the middle of both the hottest summer and the coldest winter or even consider options like prostitution or organ donation as a means of affording food is somewhat offensive when having to sit through a lecture series on how poverty impacts healthcare.

Medical education itself is becoming increasingly aware that it is an outdated model that relies on the reputation of institutional credentialing to force students to attend mandatory lectures instead of admitting that outside third party resources like Boards and Beyond could do their job better if they weren't the ones who facilitated their own in-house examinations to "best meet" what they gauge to be necessary material for what will now be a pass/fail examination.

It's a farce and the same actors keep dancing on these issues as if they bore no culpability.

 

[thegrind33]

I am taking on a lot of debt to become a doc, I want my money to be spent on teaching me how to be a doctor not a politician. Also, the point of medical schools is to prepare students for residency and help students obtain said residency. Giving political mandatory lectures will be a waste of time, and will also be very one-sided. The public is losing faith in our education system because they believe colleges are "indoctrinating" their children, and including more loaded one-sided political lectures into medical curriculum just furthers public distrust.

 

[Mkif586]

I don't think you can reasonably discount racism as a contributing factor to these health disparities.

As a thought exercise, a conservative med student/physician may be more tempted to push back on the suggested root causes of these health disparities and argue that leftist/socialist progressive economic welfare policies and messaging may be at the root of the problem (e.g. economically incentivizing single minority motherhood and therefore contributing to high rates of intergenerational low income). The supposed solutions would be to be more socially, economically, and politically conservative. I believe that a medical student would feel very uncomfortable expressing these sorts of ideas when in a lecture about health disparities because that school, as most of academia, probably leans left. So, the curriculum has a good chance of being politically-skewed.

So, if you overhaul medical education to include lectures about the social/economic determinants of health disparities, you'll end up talking about things like housing, income, food security, healthcare inequality, all of which gets very political because the big solutions to these things differ based on political stance. And if you're not going to talk about the potential big solutions to these problems, is there really a purpose to the curricular addition in the first place?

Furthermore, I'm against this game of "sprinkling" medical education with all these different subjects. I mean, we need physician-leaders who understand business, so should all med students be forced to learn organizational and financial management of heathcare systems? But, you also have to learn about health disparities? Will computer science become a lecture because of the emergence of AI in medicine?

To add to this. Don’t forget that doctors may also need to assist in billing, let’s teach accounting in medical school. What about doctors who will have to work with people who was or is in prison. How about adding criminology classes to curriculum? And there people from foreign countries reside in the US - how about mandatory classes in cultural aspects? Oh, and don’t forget that we also have people with different religious backgrounds, let’s make religious studies a mandatory class to better understand those people. We also have people of many different ages who lived in very different times, let’s make history a mandatory medical school class. How about history of medicine by the way? And we know that we will be dealing with a lot of comprehensive equipment especially as technologies advance, so classes in electrical engineering should become mandatory as well. Do you know that there are different climate zones in the US - you got me right, geography is a big deal these days, let’s add it to the curriculum. And now when everything important is covered, we can finally go and learn some anatomy.
Jokes aside, it looks more like creating a job posting: ok, we need a geek who can code in JS, but wouldn’t it be wonderful if they know c++, maybe assembler, and has some expertise in selenium webdriver, don’t forget to add “graduated from a reputable university”. The only difference Is that you really want to spend precious time to teach something that carries 0 practical value.

 

[LizzyM]

That article is a great example about what I’m saying . The url literally calls the situation systemic racism. That’s a really dishonest and malicious way to describe that one group tends to have less money for expensive services. That’s not racism, that’s the fact that services cost money. In there is the snuck premise that all services should be available regardless of ability to pay. The medical institutions shouldn’t be pushing that kind of politically loaded crap, they should focus on actual medicine

One group tends to have less money but why? Blacks have lower income than any other racial or ethnic group, why? Let's look at the systems that keep them poor: educational spending in this country is based on real estate taxes and thus there is less money for education in areas that are predominately lower income. Some communities keep lower income people out through zoning and other regulations on housing stock (minimum lot size, bans on multi-family units, etc) , and blacks have been segregated and redlined and zoned out of some communities. There is far less intergenerational wealth and I could go on and on but I'll recommend this article:

Examining the Black-white wealth gap | Brookings

A close examination of wealth in the U.S. finds evidence of staggering racial disparities.

www.brookings.edu

So if people have less money for expensive services, and they are more likely to die because of the absence of a service, we need to ask why that is happening in one of the richest countries in the world.

 

[communitysjw1996]

One group tends to have less money but why? Blacks have lower income than any other racial or ethnic group, why? Let's look at the systems that keep them poor: educational spending in this country is based on real estate taxes and thus there is less money for education in areas that are predominately lower income. Some communities keep lower income people out through zoning and other regulations on housing stock (minimum lot size, bans on multi-family units, etc) , and blacks have been segregated and redlined and zoned out of some communities. There is far less intergenerational wealth and I could go on and on but I'll recommend this article:

Examining the Black-white wealth gap | Brookings

A close examination of wealth in the U.S. finds evidence of staggering racial disparities.

www.brookings.edu

So if people have less money for expensive services, and they are more likely to die because of the absence of a service, we need to ask why that is happening in one of the richest countries in the world.

I guess I'm confused. Are you arguing that these things need to be taught in medical school?

 

[LizzyM]

I guess I'm confused. Are you arguing that these things need to be taught in medical school?

It should be taught somewhere, don't you think? College, High School, medical school?
Why do health disparities exist? is there something docs can do about it? Is it a bigger social issue that needs to be addressed systemically by all of society? Do we need to be woke? When? Where?

 

[Mkif586]

It should be taught somewhere, don't you think? College, High School, medical school?
Why do health disparities exist? is there something docs can do about it? Is it a bigger social issue that needs to be addressed systemically by all of society? Do we need to be woke? When? Where?

I think this topic is one of the most sensitive in todays media, you make an excellent point but you only cover one side of a problem by completely forgetting about individual choices which seems to be a taboo in academia. And I am 100% sure that if the class would be added to the curriculum it will make same mistakes. By the way it is already taught in HS and college, the classes are called American history and sociology.

 

[communitysjw1996]

It should be taught somewhere, don't you think? College, High School, medical school?
Why do health disparities exist? is there something docs can do about it? Is it a bigger social issue that needs to be addressed systemically by all of society? Do we need to be woke? When? Where?

I think there is a good chance of lectures becoming politicized and making more leftist assumptions about the root causes of and solutions to these sorts of issues. It's not that hard to imagine conservatives voices being squashed in these lectures. College was biased enough, and I don't want medical school to follow the same path.

I think the often-cited example is something like a low-income asthma patient making frequent visits to the hospital, when the solution could be to get them an air conditioner, which they can't afford because they don't make enough money to support a family. This gets quickly muddied by political beliefs. As a physician, do I work to give out free air conditioners to asthma sufferers in my community? Will that incentivize low-income asthma sufferers to not try to improve their living conditions, knowing that the government will give it to them for free? Etc, Etc

 

[finn_]

I think this topic is one of the most sensitive in todays media, but you only cover one side of a problem by completely forgetting about individual choices which seems to be a taboo in academia. And I am 100% sure that if the class would be added to the curriculum it will make same mistakes. By the way it is already taught in HS and college, the classes are called American history and sociology.

Of course individual choices play a role! But often which choices and opportunities someone has available to them are determined/limited by the situation into which they’re born and the society in which they live.

 

[Mkif586]

Of course individual choices play a role! But often which choices and opportunities someone has available to them are determined/limited by the situation into which they’re born and the society in which they live.

And it is hard to disagree with you. However, the question remains the same – to what extent it is a society's failure and to what your parents' and yours?